Malignant bronchial carcinoid tumor metastatic to the pituitary in a thyroid carcinoma patient: successful treatment with surgery, radiotherapy and somatostatin analog

Abstract

A carcinoid pituitary metastasis is very rare, and is reported scarcely in a few patients. We describe an unusual case of metastatic atypical bronchial carcinoid to the anterior pituitary gland in a 47-year-old male who presented with bitemporal hemianopsia and hypopituitarism. His primary bronchial carcinoid was resected two years previously. Foci of metastatic papillary thyroid carcinoma were also identified in the lung resected for the bronchial carcinoid. He thereby underwent total thyroidectomy followed by radioiodine ablative treatment. Transsphenoidal partial removal of the suprasellar mass was performed, and atypical carcinoid metastasis was identified. He received conventional fractionated sellar radiotherapy, which was supplemented with octreotide (Sandostatin LAR) injections following a positive pituitary uptake on octreotide scan. This treatment suppressed his elevated 5-HIAA urinary excretion to a normal level. His vision has returned to normal and the pituitary mass diminished in size.