HPI: K.W., a 24 year old white female, presented with reddish brown well-circumscribed papules and nodules on the trunk and axilla, present for about two years. Of note, the dermatology consult team evaluated this patient following the discovery of these skin lesions during a trans-sphenoidal resection of an enlarging suprasellar mass. Prior to admission, the patient had experienced visual field defects, weight gain, and diabetes insipidus.
PMH: Visual field defects, hypertension, weight gain (>100 pounds in 2 years), hypothyroidism, hypopituitarism, diabetes insipidus, depression/anxiety.
PSH: Two years prior, patient underwent endonasal pituitary biopsy revealing hypercellularity but no definitive pathology.
FMH: Patient notes multiple cancers in immediate and extended family, including breast, leukemia, germinoma, and meningioma.
SCH: Current smoker, denies illegal drugs and alcohol.
MED: DDVAP, levothyroxine, topiramate, prednisone.
PE: Non-tender reddish brown well-circumscribed papules and nodules on chest, abdomen, axilla (Figs1 and 2).
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