title: Pituitary metastasis of hepatocellular carcinoma presenting with panhypopituitarism: a case report.
abstract: BACKGROUND
  Metastasis to the pituitary gland is extremely rare and is often detected incidentally by symptoms associated with endocrine dysfunction. Breast and lung cancer are the most common primary metastasizing to pituitary gland. Metastasis from hepatocellular carcinoma to the pituitary gland is extremely rare, with only 10 cases having been previously reported. We present here the first case of pituitary metastasis of hepatocellular carcinoma presenting with panhypopituitarism diagnosed by magnetic resonance imaging.
  
  
  METHODS
  We report the case of an 80-year-old Japanese woman who presented with the sudden onset of hypotension and bradycardia after having previously been diagnosed with hepatocellular carcinoma. Based on low levels of pituitary hormones, she was diagnosed with panhypopituitarism caused by metastasis of the hepatocellular carcinoma to the pituitary gland. Magnetic resonance imaging with arterial spin-labeling was effective in the differential diagnosis of the intrasellar tumor. The patient died despite hormone replacement therapy because of hypovolemic shock.
  
  
  CONCLUSIONS
  Metastasis to the pituitary gland causes various non-specific symptoms, so it is difficult to diagnose. The present case emphasizes the importance of diagnostic imaging in identifying these metastases. Clinicians should consider the possibility of pituitary metastasis in patients with malignant tumors who demonstrate hypopituitarism.
authors.affiliation: Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan. kawakami@u-fukui.ac.jp.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan. hiramatz@u-fukui.ac.jp.
authors.forename: Katsushi
authors.initials: K
authors.lastname: Hiramatsu
authors.affiliation: Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan. nosat@u-fukui.ac.jp.
authors.forename: Takuto
authors.initials: T
authors.lastname: Nosaka
authors.affiliation: Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan. benzou@u-fukui.ac.jp.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Saito
authors.affiliation: Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan. naitot@u-fukui.ac.jp.
authors.forename: Tatsushi
authors.initials: T
authors.lastname: Naito
authors.affiliation: Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan. tkazuto@u-fukui.ac.jp.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan. kzzyy@u-fukui.ac.jp.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Ofuji
authors.affiliation: Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan. hidem@u-fukui.ac.jp.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Matsuda
authors.affiliation: Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan. mohtani@u-fukui.ac.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ohtani
authors.affiliation: Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan. nemotot@u-fukui.ac.jp.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Nemoto
authors.affiliation: Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan. hrykstu@u-fukui.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Suto
authors.affiliation: Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan. yamatatu.01ei@gmail.com.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan. kimura@u-fukui.ac.jp.
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Kimura
authors.affiliation: Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan. nakamoto-med2@med.u-fukui.ac.jp.
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Nakamoto
mesh_terms: D000369:Aged, 80 and over; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007018:Hypopituitarism / Q000175:diagnosis*; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D010911:Pituitary Neoplasms / Q000175:diagnosis* / Q000556:secondary*