Metastases to the pituitary gland

Abstract

<jats:p>Only 1% of all pituitary surgeries are performed to treat tumors that have metastasized to the pituitary gland; however, in certain cases of malignant neoplasms pituitary metastases do occur. Breast and lung cancers are the most common diseases that metastasize to the pituitary. Breast cancer metastasizes to the pituitary especially frequently, with reported rates ranging between 6 and 8% of cases.</jats:p> <jats:p>Most pituitary metastases are asymptomatic, with only 7% reported to be symptomatic. Diabetes insipidus, anterior pituitary dysfunction, visual field defects, headache/pain, and ophthalmoplegia are the most commonly reported symptoms. Diabetes insipidus is especially common in this population, occurring in between 29 and 71% of patients who experience symptoms.</jats:p> <jats:p>Differentiation of pituitary metastasis from other pituitary tumors based on neuroimaging alone can be difficult, although certain features, such as thickening of the pituitary stalk, invasion of the cavernous sinus, and sclerosis of the surrounding sella turcica, can indicate metastasis to the pituitary gland. Overall, neurohypophysial involvement seems to be most prevalent, but breast metastases appear to have an affinity for the adenohypophysis. Differentiating metastasis to the pituitary gland from bone metastasis to the skull base, which invades the sella turcica, can also be difficult. In metastasis to the pituitary gland, surrounding sclerosis in the sella turcica is usually minimal compared with metastasis to the skull base.</jats:p> <jats:p>Treatment for these tumors is often multimodal and includes surgery, radiation therapy, and chemotherapy. Tumor invasiveness can make resection difficult. Although surgical series have not shown any significant survival benefits given by tumor resection, the patient's quality of life may be improved. Survival among these patients is poor with mean survival rates reported to range between 6 and 22 months.</jats:p>

Pituitary metastasis from adenocarcinoma

“…The patient in question had no previous malignant history, in agreement with literature data which state that metastases may be the first manifestation of a malign tumor 1,2 . Pituitary metastases are symptomatic in only 7% of the cases 1,2 , with predominance of Diabetes insipidus (DI) [3][4][5] .…”

“…In literature, the primary neoplasias more commonly associated with pituitary metastases are breast and lung cancer, corresponding to 30-47% and 19-30% of all cases, respectively. Other sites were reported with lower frequency [1][2][3][4][5] .The patient in question had no previous malignant history, in agreement with literature data which state that metastases may be the first manifestation of a malign tumor 1,2 . Pituitary metastases are symptomatic in only 7% of the cases 1,2 , with predominance of Diabetes insipidus (DI) [3][4][5] .…”

“…In literature, the primary neoplasias more commonly associated with pituitary metastases are breast and lung cancer, corresponding to 30-47% and 19-30% of all cases, respectively. Other sites were reported with lower frequency [1][2][3][4][5] .…”

“…Pituitary metastases may have symptoms caused by the tumor mass, such as anterior pituitary dysfunctions, visual field alterations, cephalalgia and ophthalmoplegia [1][2][3][4] , the last two present in this patient. The association of ophthalmoplegia and cephalalgia is described as a sign of probable metastasis 5 .…”

“…Metastatic tumors of the pituitary gland are very rare, representing only 1% of the pituitary mass submitted to surgeries, and are frequently related to primary neoplasia of breast and lung 1,2 .…”