title: Unusual case of metastatic neuroendocrine tumor.
abstract: OBJECTIVE
  To report a rare case of metastatic growth hormone (GH)-secreting pituitary carcinoma causing acromegaly.
  
  
  METHODS
  We present a case report and review the available literature on this topic.
  
  
  RESULTS
  A 68-year-old woman presented with persistent acromegaly after treatment for a GH-secreting pituitary adenoma. Evaluation of long-standing cervical adenopathy revealed findings consistent with a metastatic neuroendocrine tumor. Further work-up revealed additional thyroid, parathyroid, and cervical masses. After operative treatment including total thyroidectomy, subtotal parathyroidectomy, partial thymectomy, and right modified radical neck dissection, the patient's symptoms diminished, and her GH levels approached the normal range. Surgical pathology findings were consistent with a GH-secreting pituitary carcinoma metastatic to the cervical lymph nodes, multinodular thyroid hyperplasia with a focus of papillary microcarcinoma, and parathyroid hyperplasia.
  
  
  CONCLUSIONS
  Overall, pituitary carcinomas are extremely rare. To date, about 100 cases have been reported in the world's literature, and of these, only 19 cases originated from GH-secreting cells. Our examination of the symptoms, signs, diagnosis, and treatment of our patient, in comparison with the previously reported cases, should enhance awareness of this unusual disease process.
authors.affiliation: Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Michele A
authors.initials: MA
authors.lastname: Manahan
authors.forename: Alan P B
authors.initials: AP
authors.lastname: Dackiw
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Ball
authors.forename: Martha A
authors.initials: MA
authors.lastname: Zeiger
mesh_terms: D000172:Acromegaly / Q000209:etiology; D000236:Adenoma / Q000150:complications / Q000473:pathology* / Q000601:surgery; D000368:Aged; D005260:Female; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000150:complications / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008207:Lymphatic Metastasis; D010282:Parathyroid Neoplasms / Q000150:complications / Q000556:secondary* / Q000601:surgery; D013953:Thymus Neoplasms / Q000150:complications / Q000556:secondary* / Q000601:surgery; D013964:Thyroid Neoplasms / Q000150:complications / Q000556:secondary* / Q000601:surgery