Metastatic Adenocarcinoma of the Prostate Manifested as a Sellar Tumor

Metastatic prostatic adenocarcinoma presenting as a pituitary mass: Shrinkage of the lesion and clinical improvement with medical treatment

“…The first signs of compression of the optic pathway in our patient began 3 years before diagnosis and gradually progressed to blindness and deficits of the oculomotor nerves, whereas diffuse bone pains caused by skeletal metastases began late in the clinical course. As in the other three patients previously reported [5][6][7], urologic symptoms were not particularly obvious at presentation. In retrospect, the diminished strength of the urinary stream and occasional nocturia could have led to a suspicion of prostatic tumor and, hence, of a metastatic sellar lesion.…”

“…Only three other cases of prostatic adenocarcinoma that first presented with neurologic symptoms resulting from a sellar metastasis have been reported in the literature [5][6][7]. The first signs of compression of the optic pathway in our patient began 3 years before diagnosis and gradually progressed to blindness and deficits of the oculomotor nerves, whereas diffuse bone pains caused by skeletal metastases began late in the clinical course.…”

“…Ransom and coworkers [9] reported that in eight patients with prior hormonal therapy the median survival time was only 3 months after the occurrence of cranial metastasis, whereas in three previously untreated patients cranial irradiation and orchidectomy led to clinical improvement and prolonged survival. Patients with sellar involvement usually have been irradiated and subjected to bilateral orchidectomy after surgical removal of the pituitary metastasis; thus, the effectiveness of the individual modalities of therapy is difficult to assess [6,7,13]. The impressive and long-lasting amelioration in the clinical picture and the considerable shrinkage of the pituitary mass that occurred in our patient during therapy with a GnRH superagonist plus flutamide have, to our knowledge, never been described previously in patients with prostatic adenocarcinoma metastatic to the brain.…”