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Interesting Case Scenarios in Endocrinology

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Dr CM Batra, New Delhi    20 November 2018

  1. Pituitary metastasis from thyroid – Only 22 cases had been reported till 2012. From 2013 to 2017, 12 more cases of pituitary metastasis have been reported but none from carcinoma thyroid.
  2. Pituitary metastasis from follicular carcinoma thyroid ­– Only 11 reported cases from world literature and none from India.
  3. In pituitary metastasis from follicular carcinoma thyroid, the tumors are larger, more invasive and anterior pituitary deficiency is rare. Diabetes insipidus does not occur.
  4. The prognosis of pituitary metastasis is poor and only one case of intrasellar metastasis has been cured so far. There is no neuroradiological imaging which could lead to a sure diagnosis.
  5. A rare case of pituitary metastasis from follicular carcinoma thyroid was presented.
  6. The treatment in this case was FNAC thyroid, total thyroidectomy; biopsy of the tissue; whole body RAI scan and 131I therapy. Radiotherapy of residual sellar and suprasellar mass was also done, following which the patient was referred to AIIMS.
  7. The patient was recommended for Tg, Tg Ab and TSH every 6 months and MRI brain every year. RAI therapy after rh-TSH was repeated 6 times in 6½ years.
  8. The treatment was successful and the patient continues to live after 10 years.
  9. In such cases, the treatment outlined above is probably the best approach to treat such a patient.
  10. Surgical treatment is difficult to perform, increases morbidity and does not increase survival.
  11. Thyroglobulin and thyroid transcription factor 1 are the tumor markers that confirm a thyroid malignancy, while cytokeratin 7 and focal staining for cytokeratin 19 confirm epithelial malignancy.

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