Pituitary metastases: presentation and outcomes from a pituitary center over the last decade

Abstract

Purpose Highlight and characterize manifestations, diagnostic/management approaches and outcomes in a contemporary cohort of patients with pituitary metastases (PM) from a large European pituitary center-over 10 years. Methods Retrospective review of PM cases between 1/2009 and 12/2018. Clinical, laboratory, imaging data at PM detection and during follow-up were analysed. Results 18 cases were identified (14 females; median age at diagnosis 61.5 years). Most common primary malignancies were lung (39%) and breast (32%). Most frequent presenting manifestation was visual dysfunction (50%). Gonadotrophin, ACTH, TSH deficiency were diagnosed in 85%, 67%, 46% of cases, respectively; diabetes insipidus (DI) was present in 17%. 33% of cases were detected during investigation for symptoms unrelated to PM. PM management included radiotherapy (44%), transsphenoidal surgery (17%), transsphenoidal surgery and radiotherapy (6%) or monitoring only (33%). One-year survival was 49% with median survival from PM detection 11 months (range 2-47). Conclusions In our contemporary series, clinical presentation of PM has evolved; we found increased prevalence of anterior hypopituitarism, decreased rates of DI and longer survival compared with older literature. Increased availability of diagnostic imaging, improvements in screening and recognition of pituitary disease and longer survival of patients with metastatic cancer may be contributing factors.

Pituitary metastasis unveiling a lung adenocarcinoma

“…The frequency of such presentation varies in the literature, possibly influenced by the time of publication (6). Interestingly, different series found that most cases of PM preceding the diagnosis of malignancy originated from lung cancers, as the case we report (3,6,7,8).…”

“…PM has been associated with end-stage disease, and therefore with a poor prognosis (1). However, survival time from PM detection appears longer than previously reported, possibly reflecting improvements in the management of advanced malignancy (3,5,6). The management of PM depends on the symptoms and extent of the lesion, but also the stage of the primary malignancy and other comorbidities.…”

“…Although diabetes insipidus (DI) has been considered the endocrine hallmark of PM due to a high prevalence in the initial series, more recent data suggest a lower frequency (1). In series of cases diagnosed over the last two decades, DI was present in less than 30% of patients (3,5,6,7). On the contrary, anterior hypopituitarism was considered uncommon in the setting of PM, but recent series found it to occur in more than 70% of patients (3,6,7).…”

“…In series of cases diagnosed over the last two decades, DI was present in less than 30% of patients (3,5,6,7). On the contrary, anterior hypopituitarism was considered uncommon in the setting of PM, but recent series found it to occur in more than 70% of patients (3,6,7). Visual dysfunction is frequently found in PM: a review of 289 cases of PM reported over 60 years found that visual impairment was the most common first manifestation, occurring in nearly half of cases (4).…”

Prostate Cancer Metastasis to the Pituitary Gland Manifesting as Corticosteroid Withdrawal, and the Impact of the Switch from Prednisone to Dexamethasone on Survival Time

“…Diabetes insipidus and visual symptoms are prominent symptoms that point to pituitary metastasis in patients with a known malignancy [ 8 ]. Many of these symptoms are due to the compression and/or invasion of surrounding structures such as cranial nerves [ 9 ]. Our patient developed a headache, which was his presenting symptom.…”