Sellar plasmacytoma presenting with symptoms of anterior pituitary dysfunction

[摘要] Sellar plasmacytomas are rare and the differential diagnosis with non-functioning pituitary adenomas might be difficultbecause of clinical and radiological resemblance. They usually present with neurological signs and intact anteriorpituitary function. Some may already have or eventually progress to multiple myeloma. We describe a case associatedwith extensive anterior pituitary involvement, which is a rare form of presentation. A 68-year-old man was referred toour Endocrinology outpatient clinic due to gynecomastia, reduced libido and sexual impotence. Physical examination,breast ultrasound and mammography confirmed bilateral gynecomastia. Blood tests revealed slight hyperprolactinemia,low testosterone levels, low cortisol levels and central hypothyroidism. Sellar MRI showed a heterogeneous sellarmass (56×60×61mm), initially suspected as an invasive macroadenoma. After correcting the pituitary deficits withhydrocortisone and levothyroxine, the patient underwent transsphenoidal surgery. Histological examination revealed aplasmacytoma and multiple myeloma was ruled out. The patient was unsuccessfully treated with radiation therapy (notumor shrinkage). Myeloma ultimately developed, with several other similar lesions in different locations. The patientwas started on chemotherapy, had a bone marrow transplant and is now stable (progression free) on lenalidomide anddexamethasone. The presenting symptoms and panhypopituitarism persisted, requiring chronic replacement treatmentwith levothyroxine, hydrocortisone and testosterone.

[学科分类] 血液学