Pituitary metastasis: a rare condition

Abstract

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.

Neoplastic metastases to the endocrine glands

“…Pituitary metastases are found in 1% of resected hypophyseal lesions and in 0.14-28.1% of all brain metastases in autopsy series, occurring mostly in patients with extensive disease (Larkin et al 2017, Di Nunno et al 2018 (Table 1). Breast (37.2%) and lung (24.2%) cancers are the most common primary malignancies associated with pituitary metastases followed by the prostate (5%), kidney (5%) and lymphoma (Ogilvie et al 2005, Javanbakht et al 2018. Other primary cancers include gastrointestinal malignancies, melanoma, pancreas, larynx, renal, liver, and the ovary (Aung et al 2002, Karamouzis et al 2003, Komninos et al 2004, Hirsch et al 2005, Moreno-Perez et al 2007.…”

“…The posterior pituitary is most frequently affected, due to its vascularisation by the inferior hypophyseal artery, accounting for 85% of cases alone or in combination with the anterior lobe supplied from the hypophyseal portal system (Komninos et al 2004, Di Nunno et al 2018. Because the posterior pituitary is smaller than the anterior, the same volume of metastatic tissue in the posterior region will produce earlier symptoms compared to the anterior one (Javanbakht et al 2018).…”

“…Pituitary metastases are most often asymptomatic, as generally found in autopsy specimens, but 2.5-18.2% of patients may demonstrate symptoms (Komninos et al 2004, He et al 2015. In recent series of pituitary metastases confirmed by biopsy or surgery, the most common clinical presentations were panhypopituitarism (27.7%) and diabetes insipidus (DI) (27.7-70%) (Di Nunno et al 2018, Javanbakht et al 2018. The presence of DI is extremely rare in pituitary adenomas and should always direct towards another pathology (Javanbakht et al 2018).…”

“…In recent series of pituitary metastases confirmed by biopsy or surgery, the most common clinical presentations were panhypopituitarism (27.7%) and diabetes insipidus (DI) (27.7-70%) (Di Nunno et al 2018, Javanbakht et al 2018. The presence of DI is extremely rare in pituitary adenomas and should always direct towards another pathology (Javanbakht et al 2018). Anterior hypopituitarism (20-37.7%), visual disturbance (30-48.8%) and headaches (35%) are also encountered, although their frequency may vary between series (He et al 2015, Di Nunno et al 2018, Javanbakht et al 2018.…”

“…The presence of DI is extremely rare in pituitary adenomas and should always direct towards another pathology (Javanbakht et al 2018). Anterior hypopituitarism (20-37.7%), visual disturbance (30-48.8%) and headaches (35%) are also encountered, although their frequency may vary between series (He et al 2015, Di Nunno et al 2018, Javanbakht et al 2018.…”