Metastatic Spread to the Pituitary

Shimon, Ilan

doi:10.1159/000506810

Cited by 40 publications

(59 citation statements)

References 18 publications

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“…Three different metastatic modalities can be hypothesized for the metastatic spread of melanoma in the pituitary: (1) melanoma cells metastasize in the posterior pituitary through the inferior pituitary artery and therefore invade the anterior pituitary; (2) melanoma cells cross the blood-brain barrier of the adenohypophysis and invade the pituitary; and (3) melanoma cells spread through lymphatic microvessels and settle in the pituitary gland (14,19). Diabetes insipidus is present in about 50% of patients with PMs of all sites, in 25-45% of cases an anterior pituitary functional deficiency was reported, visual damage in 30%, ophthalmoplegia in 25%, and headache/retroorbital pain in 20% of cases was reported (3,20,21). In pituitary melanoma metastases, the clinical presentation is the same as that observed in the case of PMs due to other neoplasms: the onset symptoms are diabetes insipidus, headache, visual problems while pituitary dysfunctions include hypothyroidism, hypocortisolism, and hypogonadism ( Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…Diabetes insipidus is present in about 50% of patients with PMs of all sites, in 25–45% of cases an anterior pituitary functional deficiency was reported, visual damage in 30%, ophthalmoplegia in 25%, and headache/retroorbital pain in 20% of cases was reported ( 3 , 20 , 21 ). In pituitary melanoma metastases, the clinical presentation is the same as that observed in the case of PMs due to other neoplasms: the onset symptoms are diabetes insipidus, headache, visual problems while pituitary dysfunctions include hypothyroidism, hypocortisolism, and hypogonadism ( Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…Pituitary MRI in all PMs usually reveals a non-homogeneous invasive sellar mass and loss of posterior bright spot. Sometimes it is difficult to differentiate PMs radiologically from adenomas or other sellar lesions; the presence of sellar bone erosion without sellar enlargement may suggest diagnosis of PM ( 3 ). At MRI, melanoma metastasis, due to melanin storage, appears with a typical hyperintensity on basal T1-weighted sequences and hypointensity on basal T2-weightedsequences; in our case pituitary imaging was in conflict: the mass was hyperintense in T2 sequences, suggesting pituitary adenoma, but the heterogeneity due to the intralesional bleeding suggested a PM.…”

Section: Discussionmentioning

confidence: 99%

“…Pituitary metastases (PM) are a rare event; lung cancer is the most common cause among men (46%) while breast cancer accounts for half of the cases in women (1,2), followed by renal, prostate and colon cancer (3-5% respectively), however, any type of tumor can metastasize in the pituitary region, including solid tumors and hematological malignancies (3). In the surgical series, PM represents <1% of patients undergoing transsphenoidal sellar mass surgery (1,4).…”

Section: Introductionmentioning

confidence: 99%

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A Rare Case of Pituitary Melanoma Metastasis: A Dramatic and Prolonged Response to Dabrafenib-Trametinib Therapy

et al. 2020

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Introduction: Pituitary metastases (PM) are rare events and to date only very few cases of melanoma PM have been described in literature up to now. Case Presentation: We describe the clinical history of a 33-year-old male patient who underwent surgical excision of an inter-scapular melanoma in 2008. The subsequent follow-up was negative for ∼10 years. In September 2018, due to the onset of a severe headache, the patient underwent a brain magnetic resonance imaging, which showed an expansive mass in the saddle and suprasellar region with a maximum diameter of 17 mm. Pituitary function tests and visual field were normal. Worsening of the headache and the appearance of a left eye ptosis led the patient to surgical removal of the lesion in October 2018. The histological examination unexpectedly showed metastasis of the melanoma. Post-operative hormonal assessment showed secondary hypothyroidism and hypoadrenalism, which were both promptly treated, and a mild hypogonadism. Three months after surgery, a sellar MRI showed a persistent, increased pituitary mass (3 cm of diameter); fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT) detected an increased radiopharmaceutical uptake in the sellar region. Due to the persistence of the disease and the evidence of a BRAF V600E mutation, in February 2019, the patient underwent a combined treatment with dabrafenib (a BRAF inhibitor) and trametinib (mitogen-activated extracellular signal-regulate kinase inhibitor). Sellar MRI performed 6 months later showed no evidence of mass in the sellar region. The patient was in a good clinical condition and did not complain of headaches or other symptoms; there were no significant side-effects from the anticancer therapy. After 13 months of treatment, the patient showed no recurrence of the disease on morphological imaging. Anticancer therapy was confirmed, replacement therapies with hydrocortisone and levothyroxine continued and the pituitary-gonadal axis was restored. Mormando et al. Dabrafenib-Trametinib in Pituitary Melanoma Metastasis Conclusion: This is a very interesting case, both for the rarity of the pituitary melanoma metastasis and for the singular therapeutic course carried out by the patient. This is the first case of a pituitary melanoma metastasis with BRAF mutation, successfully treated with the combination of dabrafenib and trametinib after incomplete surgical removal.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Rare Case of Pituitary Melanoma Metastasis: A Dramatic and Prolonged Response to Dabrafenib-Trametinib Therapy

et al. 2020

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“…Cancer metastasis to the pituitary gland or sellar region is a rare finding, encompassing less than 1% of intracranial metastatic lesions [2]. The diagnosis of metastasis to the pituitary is often made on autopsy/postmortem examinations, diagnostic biopsies, surgical resection, and debulking procedures [2]. Pituitary adenomas are slow-growing, while pituitary metastases are fast-growing and produce more profound symptoms [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Lung Cancer Metastasis to the Pituitary Gland

Myers¹,

Abdelrahman²,

Akpunonu³

2022

Cureus

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Common sites of lung cancer metastasis include the bone, brain, liver, and adrenal gland. Cancer metastasis to the pituitary gland or sellar region is a rare finding. Here, we present a case of pituitary gland metastasis from underlying lung cancer in a patient presenting with a predominance of pituitary symptoms over respiratory symptoms. A 48-year-old female was admitted to the hospital with progressive visual deficits, intractable headaches, constant nausea and vomiting, fatigue, polyuria, and polydipsia for about three months, all consistent with pituitary symptoms associated with secondary adrenal insufficiency, secondary hypothyroidism, and central diabetes insipidus.A brain MRI done two months earlier revealed a large mass in the pituitary gland and sella turcica area. Biochemical test abnormalities consistent with pituitary hormonal insufficiencies were noted, and subsequent imaging showed an enlarging pituitary mass and extensive metastases to the bones, brain, liver, adrenal gland, and lymph nodes. Bone biopsy was consistent with poorly differentiated adenocarcinoma of the lung as the primary site. The young age of this patient is uncommon compared to most patients with pituitary metastasis. Worsening pituitary symptoms with an enlarging pituitary mass and widespread metastases should alert consideration for pituitary metastasis and a search for a primary cancer site. Pituitary metastasis portrays a poor prognosis.

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