ACTA ENDOCRINOLOGICA (BUC)

Objective. Pituitary metastases are a rare entity, account for 1% of all intracranial metastases. This study aims to report a pituitary metastasis (PM) from bladder cancer and to provide a review of PM characteristics. Method. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed using PubMed for studies published between January 2014 and January 2024. Results. One hundred twenty eight patients (66 females, 62 males) were identified in the literature over the past decade. Median age was 61 years. The most common primary malignancies were lung cancer (24.2%) and breast cancer (21.1%). The most common symptom was visual impairment (46.1%). Deficiencies in adrenocorticotropic hormone (ACTH), thyroid stimulating hormone (TSH) and gonadotropin hormones were diagnosed in 46%, 40.4%, 35% of cases, respectively. Diabetes insipidus (DI) was present in 33.6% of cases and panhypopituitarism was present in 21.9% of cases. PM management included transsphenoidal surgery alone (25%), transsphenoidal surgery combined with radiotherapy (16.4%), radiotherapy alone (10.2%), or observation without intervention (10.9%). The median survival following the diagnosis of PM was 6 months. Conclusion. While PM remain a infrequent entity, prolonged lifespan of cancer patients has led to increased detection. Patients frequently present with visual disturbance,diabetes insipidus and anterior pituitary hormone deficiency. No standardized treatment guidelines exist. Surgery and/or radiotherapy are used as palliative modalities rather than curative treatments. The prognosis is generally poor and is mostly related to the stage and type of the primary tumor.

Objective. Carpal tunnel syndrome(CTS) is a neuropathy of the upper limb that is quite common in patients with active acromegaly, but the diagnosis of acromegaly is often made years after the diagnosis of CTS. But in the absence of the typical acral phenotype it is difficult to know when CTS will appear as the first symptom. Method. Here, we present a 27-year-old female patient with a history of numbness that first appeared in her right hand and 2 weeks later in her left hand. While the etiology of acute CTS was being investigated on cervical MRI, the hormonal evaluation of the incidentally detected mass in the sella turcica revealed that it was a clinically silent somatotroph adenoma. Results. Considering the patient's age, desire to have children, lack of typical acral features, the fact that these adenomas may cause phenotypic changes over time, their aggressive course and more recurrences, the decision for transsphenoidal surgery was made. The patient, who has been followed for 14 years, has two healthy children and does not have any complaints, acral phenotype or GH hormone excess. Conclusion. Awareness that acute unilateral/ bilateral CTS without any risk factors may be the first sign of clinically silent somatotrophinoma may improve the prognosis of acromegaly by preventing diagnostic delay.