PSMA PET/CT Reveals Pituitary Renal Cell Carcinoma Metastasis Mimicking Immune-Related Hypophysitis.

Asadurova, Stela; Simó, Marc; Sarria, Silvana; Cordero, Esteban; Biroli, Antonio · Clin Nucl Med · 2026

case_report · Level V

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Abstract

Pituitary metastasis from renal cell carcinoma (RCC) is exceedingly rare and may mimic pituitary macroadenoma. We report a 62-year-old man with a history of RCC and immune checkpoint inhibitor-induced hypothyroidism who presented with persistent headaches and hypopituitarism. PSMA PET/CT revealed intense uptake in a sellar lesion, raising suspicion of metastasis. Histology following transsphenoidal surgery confirmed RCC metastasis. This case underscores the utility of PSMA PET/CT in RCC staging and restaging, especially helpful in detecting atypical metastases, and highlights the challenge of differentiating metastasis from macroadenoma and immunotherapy-related complications.

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