Abstract
Background: Symptomatic pituitary metastasis is an uncommon clinical problem. It may be difficult to distinguish pituitary metastasis from pituitary adenomas both clinically and radiographically. We present our experience with these tumors and compare it with the findings in the literature.
Method: Eight cases are reported here. The medical records were reviewed concerning clinical features, radiographic findings, treatment, and outcome.
Results: Diabetes insipidus is associated with each case and was the initial manifestation of systemic malignancy in two of our patients. Half of the patients had headaches as well. Panhypopituitarism and visual field defects were noted in 25% of the patients. In 50% of the patients metastasis was limited to the pituitary gland only. All patients received radiation treatment and exogenous vasopressin. Two patients underwent resection of the tumor. Five patients died within a few months of diagnosis of pituitary metastasis. One patient died 2 years after the diagnosis and two patients were lost to follow-up.
Conclusions: When a patient with known metastatic cancer develops diabetes insipidus and has radiographic evidence of a pituitary mass, the diagnosis of metastasis is highly probable. Reasonable treatment is palliative with exogenous vasopressin and radiotherapy.
Similar content being viewed by others
References
Krol TC, Wood WS. Bronchogenic carcinoma and diabetes insipidus. Report of a case and review.Cancer 1982;49:596–9.
McCormick PC, Post KD, Kandji AD, Hays AP. Metastatic carcinoma to the pituitary gland.Br J Neurosurg 1989;3:71–80.
Noseda A, Louis O, Mockel J, Yernault JC. Case report. Diabetes insipidus from metastatic oat cell carcinoma: recovery after brain irradiation.Am J Med Sci 1985;289:27–30.
Teears R, Silverman EM. Clinicopathologic review of 88 cases of carcinoma metastatic to the pituitary gland.Cancer 1975;36:216–20.
Abrams HL, Spiro R, Goldstein N. Metastasis in carcinomaCancer 1950;3:74–85.
Cifuentes N, Pickren JW. Metastases from carcinoma of mammary gland: an autopsy study.J Surg Oncol 1979;11:193–205.
Hagerstrand I, Schoneback J. Metastases to the pituitary gland.Acta Pathol Microbiol Scand 1969;75:64–70.
Kovacs K. Metastatic cancer of the pituitary gland.Oncology 1973;27:533–42.
Max MB, Deck DF, Rottenberg DA. Pituitary metastasis: incidence in cancer patients and clinical differentiation from pituitary adenoma.Neurology 1981;31:998–1002.
Roessman U, Kaufman B, Friede RL. Metastatic lesions in the sella turnica and pituitary gland.Cancer 1970;25:478–80.
Sekiguchi S. Hypophysial disorder in mammary cancer and its relation to diabetes insipidus.Ann Surg 1916;63:297–304.
Walther HE.Krebsmetastasen. Basel, Switzerland: Benno Swabe and Co., 1948:531–2.
Duchen LW. Metastatic carcinoma in the pituitary gland and hypothalamus.J Pathol Bacteriol 1966;91:347–55.
Gurling KJ, Scott GBD, Baron DN. Metastases in pituitary tissue removed at hypophysectomy in women with mammary carcinoma.Br J Cancer 1957;11:519–22.
Houck WA, Olson KB, Horton J. Clinical features of tumor metastasis to the pituitary.Cancer 1970;26:656–9.
Charach G, Yosipov Y, Sztern M, Blum I. Central diabetes insipidus as a presenting sign of metastatic clear-cell carcinoma.Isr J Med Sci 1990;26:580–2.
Thomas WC. Diabetes insipidus [Review].J Clin Endocrinol 1957;17:565–6.
Willis RA.Spread of tumors in the human body. London: J & A Churchill, 1934:406–7.
Couldwell WT, Chandrasoma PT, Weiss MH. Pituitary gland metastases from adenocarcinoma of the prostate. Case report.J Neurosurg 1989;71:138–40.
Schubiger O, Haller D. Metastasis to the pituitary-hypothalamic axis. An MR study of 7 symptomatic patients.Neuroradiology 1992;34:131–4.
Yap H, Tashima CK, Blumerschein GR, Eckles N. Diabetes insipidus in breast cancer.Arch Intern Med 1979;139:1009–11.
Kimmel DW, O’Neill BP. Systemic cancer presenting as diabetes insipidus: clinical and radiographic features of 11 patients with review of metastatic-induced diabetes insipidus.Cancer 1983;52:2355–82.
Smulders J, Smets W. Les metastases des carcinomes mammaires. Frequence des metastases hypophysaires.Bull Cancer 1960;47:434–56.
Schubiger O. Intrasellar tumors: neuroradiological diagnosis.Riv Neurorad 1991;4(suppl 1):47–55.
Simmonds M. Ueber Sekundare Geschwulste des Hirnnhangs und ihre Bezienhungen zum und diabetes insipidus.Munch Med 1914;61:180–1.
Leramo OB, Booth JD, Zinman B, Bergeron C, Sima AFF, Morley TP. Hyperprolactinemia, hypopituitarism, and chiasmal compression due to carcinoma metastatic to the pituitary.Neurosurgery 1981;8:477–80.
Hollenhorst RW, Younge BR. Ocular manifestations produced by adenomas of the pituitary gland—analysis of 1000 cases. In: Kohler PO, Ross GT, eds.Diagnosis and treatment of pituitary tumors. Amsterdam, The Netherlands: Excerpta Medica, 1973:53.
Cryar AK, Morgan J, Rock JP, Wisgerhof M. Pituitary metastasis: lung cancer presenting as bitemporal hemianopsia with diabetes insipidus and anterior pituitary deficiency.Henry Ford Hosp Med J 1987;35:185–7.
Chiang MF, Broch M, Patt S. Pituitary metastases.Neurochirurgia 1990;33:127–31.
Eick JJ, Bell KA, Stephan MT, Fuselier HA. Metastatic renal cell carcinoma presenting as an intrasellar mass on computerized tomography.J Urol 1985;134:128–30.
Nelson PB, Robinson AG, Martinez AJ. Metastatic tumor of the pituitary gland.Neurosurgery 1987;21:941–4.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Sioutos, P., Yen, V. & Arbit, E. Pituitary gland metastases. Annals of Surgical Oncology 3, 94–99 (1996). https://doi.org/10.1007/BF02409058
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02409058