Neoplastic metastases to the endocrine glands

Abstract

Endocrine organs are metastatic targets for several primary cancers, either through direct extension from nearby tumour cells or dissemination via the venous, arterial and lymphatic routes. Although any endocrine tissue can be affected, most clinically relevant metastases involve the pituitary and adrenal glands with the commonest manifestations being diabetes insipidus and adrenal insufficiency respectively. The most common primary tumours metastasing to the adrenals include melanomas, breast and lung carcinomas, which may lead to adrenal insufficiency in the presence of bilateral adrenal involvement. Breast and lung cancers are the most common primaries metastasing to the pituitary, leading to pituitary dysfunction in approximately 30% of cases. The thyroid gland can be affected by renal, colorectal, lung and breast carcinomas, and melanomas, but has rarely been associated with thyroid dysfunction. Pancreatic metastasis can lead to exo-/endocrine insufficiency with renal carcinoma being the most common primary. Most parathyroid metastases originate from breast and lung carcinomas and melanoma. Breast and colorectal cancers are the most frequent ovarian metastases; prostate cancer commonly affects the testes. In the presence of endocrine deficiencies, glucocorticoid replacement for adrenal and pituitary involvement can be life saving. As most metastases to endocrine organs develop in the context of disseminated disease, surgical resection or other local therapies should only be considered to ameliorate symptoms and reduce tumour volume. Although few consensus statements can be made regarding the management of metastases to endocrine tissues because of the heterogeneity of the variable therapies, it is important that clinicians are aware of their presence in diagnosis.

Management of Hypopituitarism

“…PitAp may also occur with a pituitary metastasis or a metastasis may be located in a pituitary adenoma [96]. Regarding the management of hypopituitarism due to a pituitary metastasis, deficient hormone replacement treatment should be given together with surgery, radiosurgery, radiation therapy and chemotherapy, as appropriate [19,101].…”

Hallazgos histopatológicos y malignidad de masas suprarrenales en un centro de patología y citología en Bucaramanga, Santander entre 2007 y 2019

“…Lo anterior es una diferencia relevante, ya que, a nivel internacional, el órgano con mayor frecuencia de metástasis a glándula adrenal en la mayoría de los estudios es el pulmón (16,17). No obstante, también se ha descrito como primario principal el melanoma (18), cabe recalcar que las metástasis también pueden ser de mama, gástrico, renal, colon y páncreas (17,19,20). En este estudio se presentan datos que permiten conocer la distribución y el comportamiento de las lesiones a nivel de la glándula suprarrenal en población colombiana, lo cual es útil en la práctica clínica para el diagnóstico diferencial y decisiones terapéuticas.…”

Pitfalls in Challenging Thyroid Tumors: Emphasis on Differential Diagnosis and Ancillary Biomarkers

“…Thyroid metastases have been reported in 1.4-3% of all patients who have surgery for suspected thyroid cancer [112]. They account for about 2% of all thyroid malignancies and represent 2.3-7.5% of patients submitted to FNAB [113].…”

“…They account for about 2% of all thyroid malignancies and represent 2.3-7.5% of patients submitted to FNAB [113]. In autopsy studies, the lung have been reported to be the most common source of metastatic disease in the thyroid gland, whereas in clinical series, kidney accounts for the most common origin [112]. Metastatic primaries followed by kidney include the lung, breast, gastrointestinal tract, head and neck, skin, lymphoid neoplasms, and gynecological tract.…”

“…Metastatic adenocarcinoma of the lung (TTF1+, napsin A+ , PAX8-), colorectal carcinoma (β-catenin+, CDX2+, CK20+ , SATB2+, PAX8-, and often TTF1-) or endometrial carcinoma (PAX8+, often TTF1-) can also simulate primary thyroid carcinomas (with a papillary and/or follicular pattern), but metastatic carcinomas are all negative for thyroglobulin [2,112,117] (Fig. 9a-f).…”