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Unusual presentation of lung carcinoma with pituitary metastasis: a challenging diagnosis and sodium management dilemmas

SUMMARY: Pituitary metastasis (PM) is a rare complication of an advanced malignancy. Albeit rare, PM can be more detected and achieve a longer survival rate through frequent neuroimaging and newer oncology therapies. Lung cancer is the most frequent primary site, followed by breast and kidney cancer...

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Autores principales: Wong, Poh Shean, Rajoo, Subashini, Achmad Sankala, Hairuddin, Long Bidin, Mohamed Badrulnizam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bioscientifica Ltd 2022
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10259289/
https://www.ncbi.nlm.nih.gov/pubmed/37435455
http://dx.doi.org/10.1530/EO-22-0064
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author Wong, Poh Shean
Rajoo, Subashini
Achmad Sankala, Hairuddin
Long Bidin, Mohamed Badrulnizam
author_facet Wong, Poh Shean
Rajoo, Subashini
Achmad Sankala, Hairuddin
Long Bidin, Mohamed Badrulnizam
author_sort Wong, Poh Shean
collection PubMed
description SUMMARY: Pituitary metastasis (PM) is a rare complication of an advanced malignancy. Albeit rare, PM can be more detected and achieve a longer survival rate through frequent neuroimaging and newer oncology therapies. Lung cancer is the most frequent primary site, followed by breast and kidney cancers. Patients with lung cancer generally present with respiratory symptoms and are commonly diagnosed at an advanced stage already. Nevertheless, physicians should be mindful of other systemic manifestations as well as signs and symptoms related to metastatic spread and paraneoplastic syndromes. Herein, we report the case of a 53-year-old woman who presented with PM as the first sign of an undiagnosed lung cancer. Initially, her condition was a challenging diagnosis and was even complicated with diabetes insipidus (DI), which can present as severe hyponatremia when coexisting with adrenal insufficiency. This case also highlights that treating DI with antidiuretic hormone (ADH) replacement was complicated by extreme difficulties in attaining satisfactory sodium and water balance during the clinical course, with the possibility of coexistent DI and syndrome of inappropriate ADH secretion because of the underlying lung cancer. LEARNING POINTS: When patients present with pituitary mass and diabetes insipidus (DI), pituitary metastasis should be considered as an initial differential diagnosis. DI caused by pituitary adenoma is rare and is typically a late finding. DI can present as severe hyponatremia when coexisting with adrenal insufficiency. Cortisol can directly inhibit endogenous antidiuretic hormone (ADH) secretion. Patients with adrenocorticotropic hormone deficiency will have increased tonic ADH activity and subsequently reduced capacity for free-water excretion. However, when on steroid therapy, patients should be monitored for possible DI because steroids can restore free-water excretion. A substantial change in serum sodium after desmopressin treatment should eliminate the possibility of desmopressin overdose or coexistence of DI and syndrome of inappropriate ADH secretion in patients with lung cancer. Therefore, frequent monitoring of serum sodium concentrations is crucial.
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spelling pubmed-102592892023-07-11 Unusual presentation of lung carcinoma with pituitary metastasis: a challenging diagnosis and sodium management dilemmas Wong, Poh Shean Rajoo, Subashini Achmad Sankala, Hairuddin Long Bidin, Mohamed Badrulnizam Endocr Oncol Case Report SUMMARY: Pituitary metastasis (PM) is a rare complication of an advanced malignancy. Albeit rare, PM can be more detected and achieve a longer survival rate through frequent neuroimaging and newer oncology therapies. Lung cancer is the most frequent primary site, followed by breast and kidney cancers. Patients with lung cancer generally present with respiratory symptoms and are commonly diagnosed at an advanced stage already. Nevertheless, physicians should be mindful of other systemic manifestations as well as signs and symptoms related to metastatic spread and paraneoplastic syndromes. Herein, we report the case of a 53-year-old woman who presented with PM as the first sign of an undiagnosed lung cancer. Initially, her condition was a challenging diagnosis and was even complicated with diabetes insipidus (DI), which can present as severe hyponatremia when coexisting with adrenal insufficiency. This case also highlights that treating DI with antidiuretic hormone (ADH) replacement was complicated by extreme difficulties in attaining satisfactory sodium and water balance during the clinical course, with the possibility of coexistent DI and syndrome of inappropriate ADH secretion because of the underlying lung cancer. LEARNING POINTS: When patients present with pituitary mass and diabetes insipidus (DI), pituitary metastasis should be considered as an initial differential diagnosis. DI caused by pituitary adenoma is rare and is typically a late finding. DI can present as severe hyponatremia when coexisting with adrenal insufficiency. Cortisol can directly inhibit endogenous antidiuretic hormone (ADH) secretion. Patients with adrenocorticotropic hormone deficiency will have increased tonic ADH activity and subsequently reduced capacity for free-water excretion. However, when on steroid therapy, patients should be monitored for possible DI because steroids can restore free-water excretion. A substantial change in serum sodium after desmopressin treatment should eliminate the possibility of desmopressin overdose or coexistence of DI and syndrome of inappropriate ADH secretion in patients with lung cancer. Therefore, frequent monitoring of serum sodium concentrations is crucial. Bioscientifica Ltd 2022-09-06 /pmc/articles/PMC10259289/ /pubmed/37435455 http://dx.doi.org/10.1530/EO-22-0064 Text en © The authors https://creativecommons.org/licenses/by/4.0/This work is licensed under a Creative Commons Attribution 4.0 International License. (https://creativecommons.org/licenses/by/4.0/)
spellingShingle Case Report
Wong, Poh Shean
Rajoo, Subashini
Achmad Sankala, Hairuddin
Long Bidin, Mohamed Badrulnizam
Unusual presentation of lung carcinoma with pituitary metastasis: a challenging diagnosis and sodium management dilemmas
title Unusual presentation of lung carcinoma with pituitary metastasis: a challenging diagnosis and sodium management dilemmas
title_full Unusual presentation of lung carcinoma with pituitary metastasis: a challenging diagnosis and sodium management dilemmas
title_fullStr Unusual presentation of lung carcinoma with pituitary metastasis: a challenging diagnosis and sodium management dilemmas
title_full_unstemmed Unusual presentation of lung carcinoma with pituitary metastasis: a challenging diagnosis and sodium management dilemmas
title_short Unusual presentation of lung carcinoma with pituitary metastasis: a challenging diagnosis and sodium management dilemmas
title_sort unusual presentation of lung carcinoma with pituitary metastasis: a challenging diagnosis and sodium management dilemmas
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10259289/
https://www.ncbi.nlm.nih.gov/pubmed/37435455
http://dx.doi.org/10.1530/EO-22-0064
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