Current status and treatment modalities in metastases to the pituitary: a systematic review

Ng, Sam; Fomekong, Franklin; Delabar, Violaine; Jacquesson, Timothée; Enachescu, C.; Raverot, Gérald; Manet, Romain; Jouanneau, Emmanuel

doi:10.1007/s11060-020-03396-w

Cited by 31 publications

(56 citation statements)

References 36 publications

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“…The pituitary gland can be involved by metastatic lesions via the skull base, hematogenous, or meningeal spread [ 8 ]. According to a recent systematic review, the pituitary metastases (PM) are uncommon, accounting for 0.4% of intracranial metastases [ 9 ]. Almost every cancer is reported having a potential source for sellar metastasis.…”

Section: Introductionmentioning

confidence: 99%

“…PM has a poor prognosis and the management of patients with PM is palliative. The diagnosis of such malignancies is challenging because patients mostly presented nonspecific signs that could overshadow symptoms of hypopituitarism or diabetes insipidus, so the diagnosis is ultimately confirmed by histopathology [ 9 , 12 ]. Sellar masses are rarely constituted by infiltrative neoplasm (such as lymphoma), inflammatory and granulomatous diseases of the pituitary [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Nasopharyngeal B-cell lymphoma with pan-hypopituitarism and oculomotor nerve palsy: a case report and review of the literature

et al. 2020

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Background Primary nasopharyngeal lymphoma (NPL) is a very rare tumor of Waldeyer ring (WR) lymphoid tissue. It is challenging to differentiate lymphoma infiltration of pituitary from a pituitary adenoma, meningioma infiltration, and other sellar lesions to plan a suitable treatment strategy. We presented for the first time a unique case of NPL with an unusual presentation of oculomotor nerve palsy associated with pan-pituitary involvement in a diabetic patient. Case presentation A 64-year old diabetic woman with no previous history of malignancy presented with intermittent diplopia for about the last nine months. Severe headache, left eye ptosis and hypoglycemic episodes were added to her symptoms after a while. Further complaints include generalized weakness, loss of appetite, generalized musculoskeletal pain, and 6–7 kg weight loss within six months. Her family history was unremarkable. Physical examinations of eyes indicated left eye 3rd, 4th, and 6th nerve palsy. But, she was not anisocoric, and the pupillary reflexes were normal on both eyes. No lymphadenopathy, organomegaly and other abnormalities were found. Magnetic resonance imaging (MRI) showed a heterogeneous enhancement in the seller and suprasellar regions, enlargement of the stalk, parasellar dural enhancement and thickening of the sphenoid sinus without bone erosion. Also, both cavernous sinuses were infiltrated and both internal carotid arteries were encased by the neoplastic lesion. It suggested an infiltrative neoplastic lesion which compressed the cranial nerves. Pituitary hormone levels assessment indicated a pan-hypopituitarism. Following nasopharyngeal mucosal biopsy, the immunohistochemistry (IHC) findings revealed a low-grade non-Hodgkin’s B-cell lymphoma. Systemic workup, including cerebrospinal fluid (CSF) studies, bone marrow aspiration, chest and abdominopelvic high-resolution computed tomography (HRCT) indicated no other involvement by the lymphoma. After chemotherapy courses, central adrenal insufficiency, partial central diabetes incipidious (CDI) and central hypothyroidism have been resolved. To our best knowledge, we found 17 cases of NPL with cranial nerve palsy, 1 case of NPL with pan-hypopituitarism and no NPL case with both cranial nerve palsy and pituitary dysfunction. Conclusions The incidence of cranial neuropathy in patients with diabetes should not merely be attributed to diabetic neuropathy without further evaluation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nasopharyngeal B-cell lymphoma with pan-hypopituitarism and oculomotor nerve palsy: a case report and review of the literature

et al. 2020

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“…Patients with PM present in ∼50% of the cases with diabetes insipidus [4][5][6][7][8][9], which rarely occurs in patients with pituitary adenomas. Other symptoms and signs include visual damage (30%), ophthalmoplegia (25%), headache/retroorbital pain (20%), and also fatigue, weight loss, nausea/vomiting, and cognitive deterioration in 5-10% of the affected subjects [4][5][7][8].…”

Section: Symptoms At Presentationmentioning

confidence: 99%

“…Other symptoms and signs include visual damage (30%), ophthalmoplegia (25%), headache/retroorbital pain (20%), and also fatigue, weight loss, nausea/vomiting, and cognitive deterioration in 5-10% of the affected subjects [4][5][7][8]. Anterior pituitary deficiency is reported in 25-45% of the cases [4][5][6][7][8][9] with central hypothyroidism and low cortisol levels identified frequently. Hyperprolactinemia is depicted in 80% of the patients with PMs [8].…”

Section: Symptoms At Presentationmentioning

confidence: 99%

“…Interestingly, targeted radiotherapy to the pituitary given to 69% of the affected subjects was associated with significant improvement in the survival time (16 months) over untreated patients (6 months), with a trend favoring stereotactic over conventional radiotherapy [6]. Nevertheless, surgical treatment did not have any impact on the overall survival [6]. DOI: 10.1159/000506810…”

Section: Prognosismentioning

confidence: 99%

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Metastatic Spread to the Pituitary

Shimon¹

2020

Neuroendocrinology

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The pituitary fossa is an uncommon site for metastatic tumor spread. Metastatic lesions to the sellar area derived mostly from breast, lung, renal, prostate, and colon cancers, and rarely from other solid and hematologic malignancies. Almost every cancer has been reported as a source of pituitary metastasis. Pituitary metastasis can involve both the anterior and posterior lobes, but the neuro-hypophysis is mainly involved. Clinical manifestations include diabetes insipidus, hypopituitarism, headache, visual disturbances, ophthalmoplegia, and also compression of adjacent structures by aggressive tumor masses. Metastatic spread to the pituitary from a distant primary malignancy is commonly associated with metastases to other tissues and poor prognosis, unless efficient systemic targeted medical treatment is available for the primary cancer (melanoma, lymphoma).

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Hypopituitarism secondary to a pituitary metastasis in a young woman with an invasive breast carcinoma

Oueslati

Ayari

Yazidi

et al. 2021

Clinical Case Reports

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Current status and treatment modalities in metastases to the pituitary: a systematic review

Cited by 31 publications

References 36 publications

Nasopharyngeal B-cell lymphoma with pan-hypopituitarism and oculomotor nerve palsy: a case report and review of the literature

Nasopharyngeal B-cell lymphoma with pan-hypopituitarism and oculomotor nerve palsy: a case report and review of the literature

Metastatic Spread to the Pituitary

Hypopituitarism secondary to a pituitary metastasis in a young woman with an invasive breast carcinoma

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