MON-111 A Rare Case of Panhypopituitarism Secondary to Suprasellar Metastases of Cervical Adenocarcinoma

Abstract Disclosure: A. Agarwal: None. E. Jalal: None. A.C. Levine: None. Intro: Cervical adenocarcinoma accounts for 10-15% of cervical cancers worldwide, with limited literature describing brain metastases. We present a rare case of panhypopituitarism secondary to suprasellar metastases of cervical adenocarcinoma. Case: A 43-year-old female with endocervical adenocarcinoma status post chemoradiation 2 years prior presented with 3 months of worsening headaches, peripheral vision loss, unintentional 20 pound weight gain, polyuria, and polydipsia and was admitted for brain mass workup. Initial labs showed cortisol <1 mcg/dL (6.2 - 19.4 mcg/dL) after dexamethasone administration, low FSH of 1.4 mIU/mL, low LH of <0.5 mIU/mL, prolactin of 57.7 ng/mL (1.4-24 ng/mL), IGF-1 of 57 ng/mL (74-239 ng/mL), TSH of 0.119 µIU/mL (0.400-4.2 µIU/mL), free T4 of 0.53 ng/dL (0.80-1.50 ng/dL), and free T3 <1.5 ng/dL (1.6-3.0 ng/dL). Suppressed gonadal and thyroidal axes suggested panhypopituitarism. A pituitary MRI revealed a 2.3 cm suprasellar mass causing bilateral splaying of the optic nerves along with smaller masses in the left occipital lobe and parietal base. The patient underwent a bifrontal craniotomy and mass resection in the third ventricle and was started on appropriate pituitary hormone replacement therapies. Pathology report found undifferentiated metastatic carcinoma, showing p53 in >90% of tumor cell nuclei, MIB1/ki-67 proliferation index of 75%. Strong nuclear PAX8 staining was consistent with endocervical adenocarcinoma metastases to the brain. Her post-operative hospital course was complicated by severe central diabetes insipidus (DI) with sodium lability from 129-163 mEq/L (135-145 mEq/L) due to variable intake and output in the setting of delirium and impaired thirst mechanism. Given the cancer’s aggressive nature, as evidenced by the high proliferation index and initial undifferentiated pathology, and limited treatment options, the patient was transitioned to hospice care. Conclusion: This case highlights a novel presentation of severe panhypopituitarism secondary to suprasellar metastases of cervical adenocarcinoma, aiming to contribute to the limited literature on this subject. One 2024 retrospective study of cervical adenocarcinomas (n=469) showed that brain metastases were found in only 3.4% of cases (1). Given the endocrinologic implications of the mass location, management of post-operative DI was challenging. While our patient’s cause of panhypopituitarism is an extremely atypical etiology, brain metastases is a diagnosis to keep in the differential in patients with a history of endocervical carcinoma. 1. Li S, Pan W, Song J, Zhen L, Chen Y, Liu W, Zhang Y, Chen L, Huang Q, Zheng S, Zheng X. Distant organ metastasis patterns and prognosis of cervical adenocarcinoma: a population-based retrospective study. Front Med (Lausanne). 2024 May 30;11:1401700. doi: 10.3389/fmed.2024.1401700. PMID: 38873215; PMCID: PMC11169833. Presentation: Monday, July 14, 2025