Pituitary Metastasis from Renal Cell Carcinoma: Description of a Case Report

Abstract

Patient: Male, 61Final Diagnosis: Pituitary metastasis from renal cell carcinomaSymptoms: Deterioration of visual acuity and field • persisting headache • excess thirst • polyuriaMedication: —Clinical Procedure: Total body CT-scan • brain MRI • trans-sphenoidal endoscopical surgery • radiotherapy • anti-angiogenic therapySpecialty: OncologyObjective:Rare diseaseBackground:Pituitary metastasis is uncommon, breast and lung cancers being the most frequent primary tumors. Renal cell carcinoma (RCC) is a rare cause of pituitary metastases, with only a few cases described to date.Case Report:We report a case of a 61-year-old man who presented with a progressive deterioration of visual acuity and field associated with a bitemporal hemianopsia. Two years ago, he underwent radical right nephrectomy for a clear cell RCC (ccRCC). The biological tests showed pan-hypopituitarism and diabetes insipidus. Brain MRI revealed a large sellar tumor lesion bilaterally infiltrating the cavernous sinuses, which was surgically resected. Histology confirmed a ccRCC pituitary metastasis. The patient received post-surgical radiotherapy. Considering the presence of concomitant extra-pituitary metastases, treatment with sunitinib was started, followed by several lines of therapy with axitinib, everolimus, and sorafenib because of tumor progression. The patient also presented with a pituitary tumor recurrence, which was treated by stereotaxic radiotherapy. He died five years after the initial diagnosis of RCC and 30 months after the diagnosis of the pituitary metastasis.Conclusions:There are no standardized treatment guidelines for management of pituitary metastases. Pituitary surgery plays a role in symptom palliation, and it does not have any relevant impact on survival. Exclusive radiotherapy or stereotaxic radiotherapy could be an alternative to surgery in patients whose general condition is poor or who have concomitant extra-pituitary metastases.

Isolated pituitary metastasis from renal cell carcinoma in a horseshoe kidney

“…[7] Compression of cranial nerve II at the optic chiasm causing bitemporal hemianopsia (27.9%) is the most common visual defect in all pituitary metastases. [8] There were many clues to our patient's diagnosis on presentation. The onset of his symptoms was much more rapid compared with that typical of pituitary macroadenoma.…”

“…[2] Only an estimated 7% of all pituitary metastases are symptomatic. [3][4][5] We could find only 31 cases of symptomatic pituitary metastasis from RCC reported in the literature, [6][7][8] and most of these cases described diffuse metastatic disease. Isolated symptomatic pituitary metastasis from RCC, therefore, is extremely rare.…”

Masked diabetes insipidus in pituitary metastasis from breast cancer after thalamic biopsy: a case report

“…Numerous reports have indicated that metastasis to the pituitary gland is rare [ 1 , 2 , 4 , 5 ]. Specifically, pituitary metastases accounted for 0.4–0.87% of intracranial metastases [ 6 , 7 ].…”

Symptomatic Pituitary Metastasis as Initial Manifestation of Renal Cell Carcinoma: Case Report and Review of Literature

“…Also, the gastrointestinal tract, prostate, kidney, thyroid, and pancreas primary tumors are possible sources of pituitary metastases [2,3]. Renal cell carcinomas tend to very uncommonly spread to the pituitary gland [28,32,34,35]. In a case series, Gopan et al noted the average age of presentation for renal cell carcinoma metastatic to the pituitary gland to be 61 years, with most being male [32].…”