Transformation of Lactotroph Pituitary Adenoma to Metastatic Pituitary Carcinoma: A Case Report

Keegan Christensen; Midhad Mrvoljak; Chinyere L Njoku; Shrikiriti S Rajan; Moses O Evbuomwan; Mark C Smith

doi:10.7759/cureus.95326

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Transformation of Lactotroph Pituitary Adenoma to Metastatic Pituitary Carcinoma: A Case Report

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Transformation of Lactotroph Pituitary Adenoma to Metastatic Pituitary Carcinoma: A Case Report

Keegan Christensen, Midhad Mrvoljak, Chinyere L Njoku, Shrikiriti S Rajan, Moses O Evbuomwan and Mark C Smith

Curēus (Palo Alto, CA), Vol.17(10), e95326

10/24/2025

DOI: 10.7759/cureus.95326

PMCID: PMC12641381

PMID: 41293361

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Abstract

Aggressive lactotrophic pituitary adenomas rarely transform into metastatic pituitary carcinoma. Moreover, the biological drivers and molecular characteristics that differentiate pituitary adenomas from pituitary carcinomas, or a reliable biomarker for metastatic potential, remain largely unknown. Therefore, long-term monitoring through clinical examinations, laboratory testing, and imaging is crucial for the early detection of such transformations. This approach can lead to aggressive multimodal treatments, including systemic therapies and radiation. Here, we present a rare case involving a 35-year-old male patient who developed an aggressive lactotrophic pituitary adenoma resistant to surgery, radiation, and medical treatments. Five years after undergoing adjuvant radiation therapy to the pituitary gland, the patient's condition progressed, resulting in distant spinal and bony metastases. He completed palliative radiation therapy for these metastases and underwent four cycles of combination immunotherapy for maintenance. Unfortunately, he was later diagnosed with immune checkpoint inhibitor-related hepatitis due to elevated liver enzymes. The case highlights the likely contribution of subtotal resection and high proliferative potential to incomplete remission, as patients without complete remission may have an increased risk of metastatic transformation. Thus, the need for early genetic testing and a prompt multimodal treatment approach is crucial.

Details

Title: Subtitle: Transformation of Lactotroph Pituitary Adenoma to Metastatic Pituitary Carcinoma: A Case Report
Creators: Keegan Christensen - University of Iowa
Midhad Mrvoljak - Des Moines University
Chinyere L Njoku - Lagos University Teaching Hospital
Shrikiriti S Rajan - University of Iowa Health Care
Moses O Evbuomwan - University of Iowa Health Care
Mark C Smith - University of Iowa Health Care
Resource Type: Journal article
Publication Details: Curēus (Palo Alto, CA), Vol.17(10), e95326
DOI: 10.7759/cureus.95326
PMID: 41293361
PMCID: PMC12641381
NLM abbreviation: Cureus
ISSN: 2168-8184
eISSN: 2168-8184
Language: English
Date published: 10/24/2025
Academic Unit: Radiation Oncology
Record Identifier: 9985019149602771

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