Cervical vertebral body metastasis from a gonadotroph pituitary neuroendocrine tumor: illustrative case.

backgroundMetastatic dissemination of pituitary neuroendocrine tumors (PitNETs) is uncommon and portends a poor prognosis. Within this spectrum, osseous involvement of the vertebral body is particularly rare, and, specifically for the gonadotroph subtype, cervical vertebral body metastasis has not, to the authors' knowledge, been documented. OBSERVATIONS: The authors report a clinically nonfunctioning gonadotroph PitNET with histologically confirmed C5 vertebral metastasis. A 40-year-old man, who had undergone multiple surgeries for recurrent pitNET, presented with severe axial neck pain and a destructive C5 vertebral body lesion. He underwent an anterior C5 corpectomy with C4-6 reconstruction, followed by posterior lateral mass fixation for mechanical stabilization. Pathological analysis demonstrated an SF-1/follicle-stimulating hormone-positive tumor with a high Ki-67 labeling index of 10%-13%, consistent with the previous highly aggressive primary sellar lesion. Postoperative adjuvant therapy consisted of capecitabine-temozolomide and focal radiotherapy. LESSONS: This case extends the recognized spectrum of spinal dissemination in PitNETs and underscores the need for whole-axis surveillance and multimodal, multidisciplinary management in clinically aggressive PitNETs. https://thejns.org/doi/10.3171/CASE2672.