Tumor metastasis to the pituitary gland is a rare, not well-documented and life-threatening condition associated with a shortened life span. A better understanding of its clinical manifestations could lead to earlier diagnosis, appropriate therapy and potentially improving quality of life. Therefore, we retrospectively studied the charts of patients with pituitary metastases who were treated at the City of Hope National Medical Center (Duarte, CA) from 1984 to 2018. We reviewed and analyzed tumor origin, primary pituitary clinical manifestation, duration between primary tumor diagnosis and pituitary metastasis, type of treatment and patient survival. A total of 11 patients were identified with a mean age of 59.2 years and median survival following the diagnosis of metastasis of 10 months. Breast cancer and lymphoma were the most common primary origins in these cases, and diabetes insipidus and panhypopituitarism were the most common clinical manifestations of their metastasis. We also compared our results with reports in the literature published between 1957 and 2018. A total 289 patients with pituitary metastasis have been reported in the literature. Breast cancer was the most frequent primary origin of the metastasis, and visual symptoms were the most common primary manifestation. The posterior part of the pituitary is more susceptible than the anterior to metastasis. Pituitary metastasis may occur as a consequence of successful primary tumor treatment prolonging the chance of seeding. Future studies are needed to determine the molecular mechanism of metastasis to the pituitary.

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BackgroundSystemic lupus erythematosus (SLE) is an autoimmune connective-tissue disease involving multiple organs and systems. Some evidence has demonstrated that disease activity could be associated with increased risk of organ damage.ObjectivesThe aim of this study was to determine the association between systemic lupus erythematosus Disease Activity Index (SLEDAI) scores and subclinical cardiac involvement.MethodsThis cross-sectional study was conducted on 45 SLE patients (88% female; mean age: 31.2 ± 8.2 years) from 2011 to 2013 in Mashhad, Iran. The patients had no clinical signs and symptoms of cardiac problems or risk factors for cardiovascular disease and were selected consecutively. All patients underwent complete echocardiographic examinations (using two dimensional (2D) tissue Doppler and 2D speckle tracking). Disease activity was evaluated by using the SLEDAI.ResultsPatients with higher SLEDAI scores had higher pulmonary artery pressure rates (r = 0.34; P = 0.024; 95% CI (0.086 to 0.595)) and SLE durations (r = 0.43; P = 0.004; 95% CI (0.165 to 0.664). The correlation between disease duration and left ventricular mass was also significant (r = 0.43; P = 0.009; 95% CI (0.172 to 0.681)), even after adjusting for age (r = 0.405; P = 0.016). There was no correlation between SLEDAI scores or disease duration and the left/right ventricle systolic function parameters. This was true while assessing the right ventricle’s diastolic function. A statistically significant correlation was found between mitral E/E’ as an index of left ventricle diastolic impairment and the SLEDAI scores (r = 0.33; P = 0.037; 95% CI (0.074 to 0.574)) along with disease duration (r = 0.45; P = 0.004; 95% CI (0.130 to 0.662); adjusted for age: r = 0.478; P = 0.002).ConclusionsEchocardiography is a useful noninvasive technique for screening subclinical heart problems in SLE patients. Although disease activity in general should suggest a closer follow-up, regular scanning would enable earlier detection of cardiovascular involvement and should not be confined to cases with higher SLEDAI indices or longer disease durations.

Objective: Inflammation has an important role in chronic obstructive pulmonary diseases (COPD) and statins are believed to have anti-inflammatory effects beyond low-density lipoprotein cholesterol reduction. This study aimed to assess the effect of statin on the function of the right ventricle and inflammatory markers in COPD patients. Methods: A total of 76 clinically stable COPD patients were included in this randomized, double-blind study. Patients were randomly assigned to receive atorvastatin (40 mg/d) or a placebo over a period of three months. All the patients underwent spirometry, echocardiography, and high-sensitivity C-reactive protein (hsCRP) measurement at baseline and at the end of the study. Right ventricular (RV) systolic function was assessed by echocardiography using the systolic velocity of tricuspid annulus (Sm) and longitudinal strain in the base and mid segments of RV free wall (SRB, SRM). Pulmonary artery pressure (PAP) was estimated by the tricuspid regurgitation gradient. Results: Fifty-five patients (31 in atorvastatin and 24 in the placebo group) completed the course of intervention. Atorvastatin resulted in improvement in RVSB (p = 0.03) and decrease in hsCRP (p = 0.03) compared to placebo group while RV SRM was significantly improved in atorvastatin group (p = 0.01) but this change was not significant between groups (p = 0.44). Conclusion: Statins could improve the prognosis in COPD patients by improving right ventricular hemodynamic.