Apoplexy in sellar metastasis from papillary thyroid cancer: A case report and literature review

BACKGROUND: Pituitary metastasis from papillary thyroid cancer (PTC) is rare and only a few cases have been reported. CASE DESCRIPTION: We report the case of a patient who presented with visual dysfunction and panhypopituitarism. Magnetic resonance imaging revealed a pituitary tumor and hydrocephalus. Transsphenoidal surgery had been indicated, but his surgery had been postponed due to COVID-19 pandemic. During that waiting period, he showed pituitary apoplexy with consciousness disturbance, resulting in acute adrenal insufficiency and diabetes insipidus. He was urgently hospitalized and underwent transsphenoidal surgery. Rapid and permanent pathological examinations have confirmed metastasis of PTC to the pituitary. The patient also underwent serial thyroidectomy. He was also suspected to have secondary hydrocephalus and underwent lumboperitoneal shunting after excluding cerebrospinal fluid metastasis. Thereafter, his cognitive dysfunction and performance status improved dramatically. CONCLUSION: To the best of our knowledge, this is the first patient with PTC who developed pituitary apoplexy secondary to metastasis.