This month the PNA Medical Corner focuses on a study co-authored by longtime PNA member Dr. William Couldwell. It presents a case study of a woman whose prior pituitary carcinoma spread to the cervical spine. They conclude that long term monitoring of hormones after pituitary surgery is crucial.
Link:
Natural history of pituitary carcinoma with metastasis to the cervical spine: illustrative case
Nicholas T Gamboa, Christopher Wilkerson, Bornali Kundu, Brandon A Sherrod, Andrew T Dailey, William T Couldwell
- PMID: 36647250 PMCID: PMC9844525 DOI: 3171/CASE22363
Free PMC article
Abstract
Background: Pituitary carcinoma is a rare tumor of the adenohypophysis with noncontiguous craniospinal dissemination and/or systemic metastases. Given the rarity of this malignancy, there is limited knowledge and consensus regarding its natural history, prognosis, and optimal treatment.
Observations: The authors present the case of a 46-year-old woman initially treated with invasive prolactin-secreting pituitary macroadenoma who developed metastatic disease of the cervical spine 6 years later. The patient presented with acutely worsening compressive cervical myelopathy and required posterior cervical decompression, tumor resection, and instrumented arthrodesis for posterolateral fusion.
Lessons: This case underscores the importance of long-term monitoring of hormone levels and having a high clinical suspicion for metastatic disease to the spine in patients presenting with acute myelopathy or radiculopathy in the setting of previously treated invasive secreting pituitary adenoma.
Keywords: cervical myelopathy; intradural extramedullary mass; pituitary carcinoma; prolactinoma; spinal metastases; spine tumor.
Dr. William Couldwell
