ACTH-producing pituitary carcinoma presenting as the cauda equina syndrome.
A 43-year-old woman presented with incontinence, weakness, and paresthesia, consistent with the cauda equina syndrome, 10 years after having a pituitary tumor surgically removed and 4 years after excision of two "meningiomas" of the cervical cord. The patient was also hypertensive and had a cushingoid habitus. Emergent surgical decompression of the spinal cord revealed intradural metastatic adrenocorticotropic hormone-producing pituitary carcinoma. Pituitary carcinomas are rare. The majority of reported cases of adrenocorticotropic hormone-producing carcinoma have exhibited metastases outside the central nervous system. To our knowledge, this represents the first case of an adrenocorticotropic hormone-producing pituitary carcinoma presenting with the cauda equina syndrome. A review of all reported cases of pituitary carcinoma indicated that central nervous system metastases were more common than metastases to distant sites, and patients with distant metastases experienced a shorter duration of disease than did those with central nervous system metastases.
Frost
A R
AR
Department of Pathology, George Washington University Hospital, Washington, DC 20037.
Tenner
S
S
Tenner
M
M
Rollhauser
C
C
Tabbara
S O
SO
D000324:Adrenocorticotropic Hormone / Q000096:biosynthesis*; D000328:Adult; D002420:Cauda Equina; D003480:Cushing Syndrome / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D009408:Nerve Compression Syndromes / Q000209:etiology*; D010911:Pituitary Neoplasms / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D013120:Spinal Cord Neoplasms / Q000097:blood / Q000150:complications / Q000556:secondary*
D000324:Adrenocorticotropic Hormone