Pituitary apoplexy secondary to metastatic breast carcinoma into a gonadotroph cell adenoma of the pituitary

Mills, Mark T; Wharton, Stephen B.; Connolly, Daniel; Mirza, Showkat; Sinha, Saurabh

doi:10.1080/02688697.2018.1540766

Cited by 8 publications

(8 citation statements)

References 8 publications

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“…and Mils et al . ( 5 , 6 ). Differentiation between benign and metastatic pituitary gland lesions clinically can be difficult, but it is crucial for treatment options ( 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…Metastases to a pre-existing pituitary adenoma are extremely rare, with only 31 reported clinical cases in the world literature ( 4 , 5 ). Endocrinological, visual and cranial nerve complications are found to be more frequent with a dual pituitary lesion.…”

Section: Introductionmentioning

confidence: 99%

“…Endocrinological, visual and cranial nerve complications are found to be more frequent with a dual pituitary lesion. This is likely due to either hormonal hypersecretion from adenomas and/or hormonal deficiency caused by a greater mass effect ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

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A very rare case of pituitary metastasis infiltrating a non-secretory gonadotroph adenoma

Darrat

Binhussein

Beausang

et al. 2020

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Pituitary adenomas are the commonest sellar tumours. Pituitary metastases are very rare, with the most common primaries being breast and lung cancers. We report the case of an 83-year-old man with a history of breast carcinoma who presented with recent-onset headaches and progressive deterioration of visual acuity. MRI brain showed a large sellar and suprasellar mass compressing the optic chiasm and involving the pituitary stalk. Transsphenoidal debulking resulted in symptomatic relief and visual recovery. Specimen examination revealed a combination of a gonadotroph pituitary adenoma that was infiltrated by metastatic breast carcinoma. He had no symptoms of diabetes insipidus. He was subsequently treated with pituitary radiotherapy. This is a very rare presentation of a pituitary mass with mixed pathology. To our knowledge, this is the third description of a breast carcinoma metastasis into a gonadotroph cell pituitary adenoma. Highlight points: Infiltrating metastases into pituitary adenomas are very rare but do occur. To our knowledge this is the third case of breast adenocarcinoma metastasising to a gonadotroph pituitary adenoma. Pituitary metastases should always be considered in rapidly evolving pituitary symptoms in a cancer patient. Not all complex pituitary lesions are associated with panhypopituitarism. Early invasive local management (TSS and post TSS radiotherapy) can provide rapid satisfactory outcomes.

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“…and Mils et al . ( 5 , 6 ). Differentiation between benign and metastatic pituitary gland lesions clinically can be difficult, but it is crucial for treatment options ( 1 ).…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A very rare case of pituitary metastasis infiltrating a non-secretory gonadotroph adenoma

Darrat

Binhussein

Beausang

et al. 2020

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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“…PA-associated visual disturbances include decreased visual acuity in most cases [ 11 , 25 , 31 , 32 , 33 , 37 , 57 , 70 , 75 , 80 , 93 , 96 , 97 , 98 , 101 , 102 , 105 , 110 , 113 , 120 , 121 , 128 , 135 , 146 , 168 , 177 , 187 , 190 , 196 ]. Complete blindness was reported in two papers [ 199 , 212 ].…”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

“…Complete blindness was reported in two papers [ 199 , 212 ]. Visual field defects varied from (mostly common) hemianopia [ 33 , 39 , 55 , 80 , 126 , 135 , 179 , 187 , 197 ] to cranial nerve palsies manifesting as diplopia in the majority of these cases [ 32 , 34 , 35 , 49 , 50 , 58 , 63 , 66 , 68 , 75 , 84 , 85 , 91 , 92 , 114 , 115 , 117 , 127 , 130 , 142 , 147 , 150 , 157 , 163 , 164 , 186 , 191 , 194 , 195 , 207 , 214 ] followed by ptosis [ 34 , 35 , 50 , 59 , 75 , 77 , 79 ,…”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

et al. 2023

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Various complications of pituitary neuroendocrine tumors (PitNET) are reported, and an intratumor hemorrhage or infarct underlying pituitary apoplexy (PA) represents an uncommon, yet potentially life-threatening, feature, and thus early recognition and prompt intervention are important. Our purpose is to overview PA from clinical presentation to management and outcome. This is a narrative review of the English-language, PubMed-based original articles from 2012 to 2022 concerning PA, with the exception of pregnancy- and COVID-19-associated PA, and non-spontaneous PA (prior specific therapy for PitNET). We identified 194 original papers including 1452 patients with PA (926 males, 525 females, and one transgender male; a male-to-female ratio of 1.76; mean age at PA diagnostic of 50.52 years, the youngest being 9, the oldest being 85). Clinical presentation included severe headache in the majority of cases (but some exceptions are registered, as well); neuro-ophthalmic panel with nausea and vomiting, meningism, and cerebral ischemia; respectively, decreased visual acuity to complete blindness in two cases; visual field defects: hemianopia, cranial nerve palsies manifesting as diplopia in the majority, followed by ptosis and ophthalmoplegia (most frequent cranial nerve affected was the oculomotor nerve, and, rarely, abducens and trochlear); proptosis (N = 2 cases). Risk factors are high blood pressure followed by diabetes mellitus as the main elements. Qualitative analysis also pointed out infections, trauma, hematologic conditions (thrombocytopenia, polycythemia), Takotsubo cardiomyopathy, and T3 thyrotoxicosis. Iatrogenic elements may be classified into three main categories: medication, diagnostic tests and techniques, and surgical procedures. The first group is dominated by anticoagulant and antiplatelet drugs; additionally, at a low level of statistical evidence, we mention androgen deprivation therapy for prostate cancer, chemotherapy, thyroxine therapy, oral contraceptives, and phosphodiesterase 5 inhibitors. The second category includes a dexamethasone suppression test, clomiphene use, combined endocrine stimulation tests, and a regadenoson myocardial perfusion scan. The third category involves major surgery, laparoscopic surgery, coronary artery bypass surgery, mitral valvuloplasty, endonasal surgery, and lumbar fusion surgery in a prone position. PA in PitNETs still represents a challenging condition requiring a multidisciplinary team from first presentation to short- and long-term management. Controversies involve the specific panel of risk factors and adequate protocols with concern to neurosurgical decisions and their timing versus conservative approach. The present decade-based analysis, to our knowledge the largest so far on published cases, confirms a lack of unanimous approach and criteria of intervention, a large panel of circumstantial events, and potential triggers with different levels of statistical significance, in addition to a heterogeneous clinical picture (if any, as seen in subacute PA) and a spectrum of evolution that varies from spontaneous remission and control of PitNET-associated hormonal excess to exitus. Awareness is mandatory. A total of 25 cohorts have been published so far with more than 10 PA cases/studies, whereas the largest cohorts enrolled around 100 patients. Further studies are necessary.

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“Intrasellar tumor-to-tumor metastasis: A single center experience with a systematic review”

Mansur,

Alsavaf,

Pasquini

et al. 2024

Pituitary

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Purpose This study investigates the rare occurrence of tumor-to-tumor metastasis in Pituitary Neuroendocrine Tumors (PitNETs), also known as pituitary adenomas, aiming to enhance understanding of its diagnostic and therapeutic challenges. We report two cases from our institution of tumor-to-tumor metastasis involving PitNETs, followed by a systematic literature review. Methods We conducted a comprehensive literature review using PubMed and Google Scholar databases. This review provides insights into patient demographics, clinical presentations, primary tumor origin, management approaches and outcomes. Results We identified 38 documented cases of tumor-to-tumor metastasis involving the pituitary gland in the literature. This revealed a diverse range of primary tumor origins, with lung, breast, and renal carcinomas being the most prevalent. Clinical presentations varied, with visual disturbances emerging as the most frequently reported symptom. Surgical interventions predominantly resulted in subtotal resection. Kaplan–Meier survival analysis demonstrated that endoscopic endonasal approaches (EEA) are associated with longer median survival times compared to other surgical methods. Conclusion Tumor-to-tumor metastasis to PitNETs must be considered in differential diagnoses of sellar masses. Prompt and accurate diagnosis, coupled with a multidisciplinary treatment strategy, is essential. Our study contributes to the scarce literature on such metastases, providing a foundation for further understanding of this complex pathological entity.

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Pituitary apoplexy secondary to metastatic breast carcinoma into a gonadotroph cell adenoma of the pituitary

Cited by 8 publications

References 8 publications

A very rare case of pituitary metastasis infiltrating a non-secretory gonadotroph adenoma

A very rare case of pituitary metastasis infiltrating a non-secretory gonadotroph adenoma

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

“Intrasellar tumor-to-tumor metastasis: A single center experience with a systematic review”

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