Pituitary gland metastasis from renal cell carcinoma presented as a non-functioning macroadenoma

Abstract

Metastatic tumors involving the pituitary gland are an uncommon finding and occur in up to 1% of all pituitary tumor resections. A 74-year-old man had progressive vision deterioration, over the 30 days prior to consultation. He did not complain of headache or polyuria, but referred to intestinal constipation. Five years ago, he underwent a right radical nephrectomy for renal cell carcinoma, followed by chemotherapy and radiotherapy for lung and parotid metastases. On ophthalmologic examination, there was a left abducens nerve palsy and bitemporal hemianopia. Magnetic resonance imaging demonstrated a sellar mass with suprasellar cistern extension compressing the optic chiasm. Endocrinological evaluation revealed central adrenal and gonadal insufficiencies. The patient underwent a transsphenoidal tumor resection that revealed renal cell carcinoma. This case illustrates that metastatic pituitary lesions can mimic typical symptoms and signs of pituitary macroadenoma. Furthermore, clinical diabetes insipidus, a common finding of pituitary metastases, can be absent.

Endoscopic Endonasal Management of Metastatic Lesions of the Anterior Skull Base: Case Series and Literature Review

“…A series of 190 symptomatic pituitary metastases identified DI in 45.2% of patients (7,16,19,21,33,38). The causes for frequent involvement of the posterior lobe were the relatively wide contact with the adjacent dura and the direct arterial supply from the hypophyseal arteries, in contrast to the anterior lobe, which receives its blood supply from the hypophyseal portal system (7,16,19,23,32,33,38). In other studies, the most common presenting symptom was headache (60%e70%), followed by hypopituitarism (505e60%), visual field defect (50%), and DI (30%) (1,4,11,33).…”

“…The transnasal corridor can also be used to access the odontoid to treat the lower clivus and craniocervical junction. Closure was accomplished according to an established closure algorithm for endonasal endoscopic skull base surgeries from Weill Cornell Medical College New York Presbyterian Hospital (7,16,19,23,32,33,38).…”

Isolated pituitary metastasis from renal cell carcinoma in a horseshoe kidney

“…[9][10][11] Breast and lung cancers are the most common primary source for pituitary metastasis, making up 37.2% and 24.2% of cases respectively. The next most common primary sites are prostate (5%) and kidney, specifically renal cell carcinoma (2.6%) respectively.…”

Diplopía y ptosis palpebral izquierda como primera manifestación de metástasis hipofisarias de adenocarcinoma pulmonar

“…Es difícil diferenciar metástasis hipofisarias de metástasis óseas en la base del cráneo, pero al parecer el aumento de esclerosis que se detecta en éstas, es punto clave para ello. Existe un caso descrito además del que exponemos en el que se observan metástasis hipofisarias de cáncer pulmonar exclusivamente en adenohipófisis y en los dos pacientes coincide tener metástasis óseas cervicales que pudieran haber metastatizado a la base del cráneo 11 .También se ha observado este fenómeno en cáncer de hígado, riñón y tiroides, presumiblemente por el mecanismo descrito 3,12 . En el estudio de toda masa hipofisaria debe plantearse el diagnóstico diferencial de metástasis hipofisarias, especialmente en los pacientes mayores de 55 años con diabetes insípida central o con panhipopituitarismo de rápida instauración y síndro-me constitucional de etiología no filiada.…”