Hyperprolactinemia, Hypopituitarism, and Chiasmal Compression Due to Carcinoma Metastatic to the Pituitary

Leramo, Olusegun B.; Booth, John D.; Zinman, B.; Bergeron, Catherine; Sima, Anders A. F.; Morley, Thomas

doi:10.1227/00006123-198104000-00015

Cited by 38 publications

(19 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Of note is that in approximately 3% of cases the primary tumor remains undetected despite intensive investigation (Table 3) Symptoms from MPs are reported in 2.5-18.2% of cases (3,4,9,13,15,16,24), mostly because they occur in end stage cancer patients and do not have the time to become evident (12,25). In addition, systemic complications of malignancy, including nonspecific symptoms (weakness, vomiting, weight loss) and central nervous system involvement, may mask anterior pituitary deficiency (5).…”

Section: Discussionmentioning

confidence: 99%

Tumors Metastatic to the Pituitary Gland: Case Report and Literature Review

Komninos

Vlassopoulou

Protopapa

et al. 2004

The Journal of Clinical Endocrinology & Metabolism

373

569

View full text Add to dashboard Cite

Tumors metastatic to the pituitary gland are an unusual complication of systemic cancer typically seen in elderly patients with diffuse malignant disease. Breast and lung are the commonest sites of the primary tumor, whereas diabetes insipidus is the most frequent symptom at presentation. Their rarity and usually indolent course, as well as the lack of specific clinical and radiological features, impede their differentiation from other more common sellar area lesions, particularly when history of malignancy is absent. Management of these patients may also be very difficult because the prognosis depends on the course of the primary neoplasm. A 68-yr-old man, with no history of malignancy, presented with recent onset of hypopituitarism, mild diabetes insipidus, headaches, left oculomotor nerve palsy, and progressive bilateral deterioration of visual acuity and visual fields. Magnetic resonance imaging revealed a large sellar mass compressing the optic chiasm and invading the left cavernous sinus, whereas a prolactin elevation at 438.6 ng/ml (19.73 nmol/liter) was noted. Decompression of the sellar region was attempted, and pathology disclosed a metastatic hepatocellular carcinoma. On postoperative investigation, primary liver tumor was identified and confirmed by biopsy. The patient improved transiently but died 3 months after diagnosis because of deterioration of the liver disease. The relevant literature is reviewed in light of this unusual case, illustrating the problems in the diagnosis and management of patients with metastasis to the pituitary.

show abstract

Section: Discussionmentioning

confidence: 99%

Tumors Metastatic to the Pituitary Gland: Case Report and Literature Review

Komninos

Vlassopoulou

Protopapa

et al. 2004

The Journal of Clinical Endocrinology & Metabolism

373

569

View full text Add to dashboard Cite

show abstract

“…Another possible interpretation of the initial hyperprolactinemia is that hypothalamus-derived prolactin inhibiting factor, which is considered to be dopamine, is blocked by the infundibular invasion of the pituitary metastasis. Such a condition is thought to be rare (6,17,19). Twentyfour-hour urinary 17-OHCS was within the normal range, which is inconsistent with the reduced plasma and urinary cortisol levels.…”

Section: Discussionmentioning

confidence: 94%

“…The reported incidence of pituitary metastasis is 1%to 6% (3)(4)(5). Breast cancer is the disease most frequently associated with pituitary metastases followed by lung cancer (6)(7)(8). Although diabetes insipidus secondary to cancer metastasis to the pituitary gland is a common manifestation, anterior pituitary failure is rare.…”

Section: Introductionmentioning

confidence: 99%

Hypopituitarism due to Pituitary Metastasis of Lung Cancer: Case of a 21-Year-Old Man.

et al. 2001

View full text Add to dashboard Cite

A 21-year-old man presented persistent dry cough, general malaise, loss of appetite, decreased sexual desire and double vision. Chest radiograph revealed a mass shadow in the left upper lobe. Histopathological diagnosis of the tumor was squamouscell carcinoma. Brain computedtomographyand magnetic resonance imaging revealed a metastasis to the pituitary gland. Hypopituitarism was diagnosed by pituitary function tests. Diabetes insipidus was absent and the function of the posterior lobe of the pituitary gland was preserved. Hypopituitarism due to pituitary metastasis is a rare complication of lung cancer, and has never been reported in a patient as young as 21 years old. (Internal Medicine 40: 414-417, 2001)

show abstract

“…A previous study reported that hyperprolactinaemia is present in 6.3% of pituitary metastases, and that levels >200 ng/ml are suggestive of a prolactinoma (7). Mean prolactin levels in cases of pituitary metastasis are ~150 ng/ml and are believed to result from stalk compression (12). In agreement with this, none of the patients in the present study demonstrated prolactin levels >200 ng/ml, but the two with pituitary metastases did exhibit high prolactin levels of ~150 ng/ml on at least one occasion during the study.…”

Section: Discussionmentioning

confidence: 96%

Pituitary lesions in breast cancer patients: A report of three cases

et al. 2015

View full text Add to dashboard Cite

Abstract.Pituitary metastases occur in 6-8% of breast cancer cases, but are seldom diagnosed and rarely reported. Therefore, it can be challenging to establish a clinical differential diagnosis, and at present, a definitive criteria is not available. The present study discusses the pituitary lesions identified in three patients with breast cancer, and describes their management within the collaborative framework of the Breast Unit at the Città della Salute Hospital, which also included assessment by endocrinologists. The patients were evaluated for anterior and posterior pituitary function, the appearance of the pituitary upon magnetic resonance imaging (MRI), and the oncology status and treatment. In addition, successive analysis of prolactin levels and the MRI was performed. The patients, aged 75, 83 and 76 years old, differed in their clinical presentation and successive evolution. One patient demonstrated an abrupt onset of diabetes insipidus, the second exhibited overt hypopituitarism and the final patient had a pituitary mass discovered by chance. Cases one and three exhibited systemic spread of the breast cancer, with bone and/or parenchymal metastasis, but not brain metastasis. Case two presented with a secondary pituitary tumour alone. In case three, a secondary nature to the pituitary lesion was unlikely, since there was no lesion evolution evident following MRI and as stable prolactin levels were observed over the course of the study period. By contrast, case one presented with a rapid increase of sellar lesions on MRI, together with a progressive rise in prolactin levels. Taking into account the frailty of breast cancer patients who are monitored for disease progression, management in a collaborative framework, such as at the Breast Unit, makes it possible to establish a diagnosis of sellar lesions, which is adequate for the comprehensive management of the patient with successive pituitary MRIs and prolactin evaluations, and avoids unnecessary invasive neurosurgery. IntroductionIn breast cancer patients, the development of metastatic disease is considered to be the major cause of mortality (1). The invasion-metastasis cascade is a multistep process in which breast cancer cells invade the systemic circulation and distant tissues, and cause the metastatic colonization of different organs, including the bones, lungs and central nervous system (2). Being highly vascularized, the pituitary gland is a target structure for metastatic spread, accounting for 0.14-28% of all reported brain metastases following autopsy (3). In total, 6-8% of breast cancer cases demonstrate metastatic spread to the pituitary gland (4). Despite this, pituitary metastases are seldom diagnosed and rarely described in surgical series, overall representing just 1% of surgically-resected tumours in the sellar region (5). The clinical differential diagnosis of benign lesions in the sellar region is challenging, and at present, a definitive clinical criteria is not available (6). The majority of patients may be asymptomatic, but the mos...

show abstract

Hyperprolactinemia, Hypopituitarism, and Chiasmal Compression Due to Carcinoma Metastatic to the Pituitary

Abstract: Carcinoma metastatic to the anterior pituitary gland may simulate prolactinoma. We are reporting a case of chiasmal compression and hyperprolactinemia caused by metastatic adenocarcinoma.

Cited by 38 publications

References 0 publications

Tumors Metastatic to the Pituitary Gland: Case Report and Literature Review

Tumors Metastatic to the Pituitary Gland: Case Report and Literature Review

Hypopituitarism due to Pituitary Metastasis of Lung Cancer: Case of a 21-Year-Old Man.

Pituitary lesions in breast cancer patients: A report of three cases

Contact Info

Product

Resources

About