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Sahel OA, Benameur Y, Nabih SO, Biyi A, Doudouh A. A rare case of pituitary metastasis from breast cancer detected on fluorodeoxyglucose positron emission tomography/computed tomography that presented as insipid diabetes. World J Nucl Med 2021; 20:211-214. [PMID: 34321980 PMCID: PMC8286001 DOI: 10.4103/wjnm.wjnm_88_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/28/2020] [Accepted: 08/14/2020] [Indexed: 11/08/2022] Open
Abstract
Pituitary metastases are rare, are generally asymptomatic, and often remain undiagnosed. Breast cancer is the most common primary cancer metastasizing to hypophysis in women. However, it is difficult to clinically and radiologically differentiate pituitary metastases from pituitary adenomas. We report a case of pituitary metastases diagnosed on magnetic resonance imaging and positron emission tomography/computed tomography, which was the prime manifestation of a breast cancer in a 46-year-old female. This cancer was revealed by insipid diabetes.
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Affiliation(s)
- Omar Ait Sahel
- Department of Nuclear Medicine, Military Hospital of Instruction Mohamed V, Rabat, Morocco
| | - Yassir Benameur
- Department of Nuclear Medicine, Military Hospital of Instruction Mohamed V, Rabat, Morocco
| | - Salah Oueriagli Nabih
- Department of Nuclear Medicine, Military Hospital of Instruction Mohamed V, Rabat, Morocco
| | - Abdelhamid Biyi
- Department of Nuclear Medicine, Military Hospital of Instruction Mohamed V, Rabat, Morocco
| | - Abderrahim Doudouh
- Department of Nuclear Medicine, Military Hospital of Instruction Mohamed V, Rabat, Morocco
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2
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Gandhi GY, Fung R, Natter PE, Makary R, Balaji KC. Symptomatic Pituitary Metastasis as Initial Manifestation of Renal Cell Carcinoma: Case Report and Review of Literature. Case Rep Endocrinol 2020; 2020:8883864. [PMID: 32908722 PMCID: PMC7450332 DOI: 10.1155/2020/8883864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/30/2020] [Accepted: 08/01/2020] [Indexed: 02/07/2023] Open
Abstract
Metastasis to the pituitary gland is extremely rare (∼2% of sellar masses). Clinical, biochemical, and radiologic characteristics of pituitary metastasis are poorly defined and can be difficult to diagnose before surgery. We present an unusual case with pituitary metastasis as the first manifestation of renal cell carcinoma (RCC). A 70-year-old male presented with acute onset of weakness, dizziness, diplopia, and progressively worsening headache. The initial CT head revealed a heterogeneous sellar mass measuring 2.8 × 1.9 × 1.7 cm. A follow-up MRI showed the sellar mass invading the right cavernous sinus. The presumptive diagnosis was a pituitary macroadenoma. Physical examination revealed bilateral 6th cranial nerve palsy and episodes of intermittent binocular horizontal diplopia. Hormonal testing noted possible secondary adrenal insufficiency (AM serum cortisol: 3.3 mcg/dL, ACTH: 8 pg/mL), secondary hypothyroidism (TSH: <0.01 mIU/L, FT4: 0.7 ng/dL), secondary hypogonadism (testosterone: 47 ng/dL, LH: 1.3 mIU/mL, and FSH: 2.3 mIU/mL), and elevated serum prolactin (prolactin: 56.8 ng/ml, normal: 4.0-15.2 ng/ml). IGF-1 level was normal at 110 ng/mL (47-192 ng/mL). The patient was discharged on levothyroxine and hydrocortisone therapy with plans for close surveillance. However, his condition worsened over the next three months, and he was subsequently readmitted with nausea, vomiting, and hypernatremia secondary to diabetes insipidus. Repeat MRI pituitary showed an interval increase in the size of the sellar mass with suprasellar extension and a new mass effect on the optic chiasm. The sellar mass was urgently resected via a trans-sphenoidal approach. The tumor was negative for neuroendocrine markers and pituitary hormone panel, ruling out the diagnosis of pituitary adenoma and triggered workup for metastatic renal cell carcinoma, clear cell type. The diagnosis of renal cell carcinoma was confirmed by the diffuse and strong staining for renal cell carcinoma markers (Pax-8, RCC-1, and CD10). A follow-up CT scan noted large right renal mass measuring 11 × 10 × 11 cm. The patient underwent a cytoreductive robotic right radical nephrectomy for WHO/ISUP histologic grade II clear cell RCC, stage pT2b pNX pM1. He subsequently received fractionated stereotactic radiotherapy to the pituitary gland. He is presently stable with no radiological evidence of progression or new intracranial disease on subsequent imaging. Pituitary metastasis most commonly occurs from breast, lung, or gastrointestinal tumors but also rarely from renal cell carcinoma. Biochemical findings such as panhypopituitarism, acute clinical signs such as headache, visual symptoms, and diabetes insipidus and interval increase in sellar mass in a short time interval should raise suspicion for sellar metastasis.
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Affiliation(s)
- Gunjan Y. Gandhi
- Division of Endocrinology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
- Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Russell Fung
- Division of Endocrinology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
- Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Patrick E. Natter
- Department of Radiology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Raafat Makary
- Department of Pathology and Laboratory Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - K. C. Balaji
- Department of Urology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
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Shahein M, Albonette-Felicio T, Carrau RL, Prevedello DM. Sellar Metastases: Diagnosis and Management. Neurosurg Clin N Am 2020; 31:651-658. [PMID: 32921359 DOI: 10.1016/j.nec.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sellar metastases account for 0.87% of all intracranial metastases. They are usually asymptomatic and can be the first manifestations of some occult malignancy. The diagnosis is made mainly during the screening of patients with known primary lesions or can present with neurologic or hormonal changes related to compression or invasion of surrounding structures. Differentiating these lesions from other more common lesions such as pituitary adenoma maybe difficult. Management is mainly aimed at the primary lesion and is palliative to improve quality of life or for pathologic confirmation.
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Affiliation(s)
- Mostafa Shahein
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, N-1049 Doan Hall, W. 10th Avenue, Columbus, OH 43210, USA; Department of Neurological Surgery, Aswan University, Egypt
| | - Thiago Albonette-Felicio
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, N-1049 Doan Hall, W. 10th Avenue, Columbus, OH 43210, USA
| | - Ricardo L Carrau
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, N-1049 Doan Hall, W. 10th Avenue, Columbus, OH 43210, USA; Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, N-1049 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210, USA
| | - Daniel M Prevedello
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, N-1049 Doan Hall, W. 10th Avenue, Columbus, OH 43210, USA; Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, N-1049 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210, USA.
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Wendel C, Campitiello M, Plastino F, Eid N, Hennequin L, Quétin P, Longo R. Pituitary Metastasis from Renal Cell Carcinoma: Description of a Case Report. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:7-11. [PMID: 28044054 PMCID: PMC5223779 DOI: 10.12659/ajcr.901032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND 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.
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Affiliation(s)
- Chloé Wendel
- Division of Medical Oncology, Regional Hospital Center (CHR) Metz-Thionville, Ars-Laquenexy, France
| | - Marco Campitiello
- Division of Medical Oncology, Regional Hospital Center (CHR) Metz-Thionville, Ars-Laquenexy, France
| | - Francesca Plastino
- Division of Medical Oncology, Regional Hospital Center (CHR) Metz-Thionville, Ars-Laquenexy, France
| | - Nada Eid
- Division of Medical Oncology, Regional Hospital Center (CHR) Metz-Thionville, Ars-Laquenexy, France
| | - Laurent Hennequin
- Division of Radiology, Regional Hospital Center (CHR) Metz-Thionville, Ars-Laquenexy, France
| | - Philippe Quétin
- Division of Radiotherapy, Regional Hospital Center (CHR) Metz-Thionville, Ars-Laquenexy, France
| | - Raffaele Longo
- Division of Medical Oncology, Regional Hospital Center (CHR) Metz-Thionville, Ars-Laquenexy, France
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Feghaly J, Astras G. Diagnosis and management of isolated pituitary metastasis from adenocarcinoma of unknown origin presenting as loss of libido. BMJ Case Rep 2015; 2015:bcr-2014-208735. [PMID: 25827917 DOI: 10.1136/bcr-2014-208735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pituitary gland metastasis from primary tumours is uncommon on its own. Rarely, some of these primary tumours may be of unknown origin. This metastasis to the pituitary gland could manifest as diabetes insipidus, cranial nerve palsies, headaches, fatigue and other symptoms. In rare cases, it could present as loss of libido. We describe here this rare presentation, loss of libido, examine the diagnosis and management undertaken, and provide a systematic review of the literature for similar cases.
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Affiliation(s)
- Julien Feghaly
- St George's University of London, Cyprus, Nicosia, Cyprus
| | - George Astras
- Department of Oncology, American Medical Center, Nicosia, Cyprus
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Jian F, Bian L, Sun S, Yang J, Chen X, Chen Y, Ma Q, Miao F, Wang W, Ning G, Sun Q. Surgical biopsies in patients with central diabetes insipidus and thickened pituitary stalks. Endocrine 2014; 47:325-35. [PMID: 24532100 DOI: 10.1007/s12020-014-0184-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
Abstract
Thickened pituitary stalks (TPSs) on magnetic resonance imaging (MRI) result from diverse pathologies; therefore, it is essential to make specific diagnoses for clinical decision-making. The diagnoses and indications for surgical biopsies in patients with central diabetes insipidus (CDI) and TPSs are thoroughly discussed in this paper. Thirty-seven patients with CDI and TPSs were retrospectively reviewed. The mean age at the diagnosis of CDI was 29.0 ± 15.9 years (range 8.0-63.3), and the median duration of follow-up was 5.5 ± 2.8 years (range 0.7-13.0). Anterior pituitary hormone deficiencies were documented in 26 (70.3 %) patients. All patients had a TPS on MRI at the diagnosis of CDI, and 21 (56.8 %) patients exhibited radiological changes during the follow-up. Of these 21 patients, 11 exhibited increases in the thickness of the stalk, and two patients exhibited reversals of the TPSs. Involvements of the hypothalamus, pituitary gland, basal ganglia or supersellar, and pineal gland were found in four, three, one, and 1 patient, respectively. Ultimately, clear diagnoses were established in 17 patients who underwent biopsies, nine of whom had germinomas, six of whom had Langerhans cell histiocytosis, one of whom had a granular cell tumor, and one of whom had Erdheim-Chester disease. Patients with CDI and TPSs should submit to periodic clinic follow-ups with serial MRI assessments to establish anterior pituitary deficiencies and to detect radiological progressions that are appropriate for surgical biopsies. Endoscopic-assisted microsurgery via the supraorbital keyhole approach is a good choice for the biopsy of pituitary stalk lesions.
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Affiliation(s)
- Fangfang Jian
- Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
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Ismail E, Issam L, Hamid M. Pituitary metastasis of rhabdomyosarcoma: a case report and review of the literature. J Med Case Rep 2014; 8:144. [PMID: 24885254 PMCID: PMC4036491 DOI: 10.1186/1752-1947-8-144] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 03/03/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The pituitary gland is an uncommon site for metastases, in particular from rhabdomyosarcoma. Some authors have reported a recent increase in the incidence of metastases at infrequent sites, such as brain or bone, probably due to the expanded treatment options and the resulting improved survival. Treatment options are limited, but must be discussed and adapted to the patient profile. CASE PRESENTATION We report the case of a 17-year-old Arabic man, diagnosed with alveolar rhabdomyosarcoma of the left shoulder, who, after several cycles of chemotherapy, presented symptoms and signs of pituitary dysfunction. To the best of our knowledge, it is the first case described. CONCLUSIONS Pituitary metastasis of rhabdomyosarcoma is a rare situation, which must be actively researched to have access to an optimal therapeutic approach.
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Affiliation(s)
- Essadi Ismail
- Medical Oncology, Ibn Sina Military Hospital, Marrakesh, Morocco.
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8
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Metastatic prostate adenocarcinoma presenting central diabetes insipidus. Case Rep Med 2012; 2012:452149. [PMID: 22474455 PMCID: PMC3312572 DOI: 10.1155/2012/452149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 01/15/2012] [Indexed: 11/17/2022] Open
Abstract
The pituitary gland and infundibulum can be involved in a variety of medical conditions, including infiltrative diseases, fungal infections, tuberculosis, and primary and metastatic tumors. Metastases to the pituitary gland are absolutely rare, and they are generally secondary to pulmonary carcinoma in men and breast carcinoma in women. Pituitary metastases more commonly affect the posterior lobe and the infundibulum than the anterior lobe. The posterior lobe involvement may explain why patients with pituitary metastases frequently present with diabetes insipidus. We are presenting a case report of a 78-year-old male patient who had metastatic prostate with sudden onset of polyuria and persistent thirst. He had no electrolyte imbalance except mild hypernatremia. The MRI scan of the brain yielded a suspicious area in pituitary gland. A pituitary stalk metastasis was found on magnetic resonance imaging (MRI) of pituitary. Water deprivation test was compatible with DI. A clinical response to nasal vasopressin was achieved and laboratory results revealed central diabetes insipidus. As a result, the intrasellar and suprasellar masses decreased in size, and urinary output accordingly decreased.
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Sellar and parasellar metastatic tumors. Int J Surg Oncol 2011; 2012:647256. [PMID: 22312541 PMCID: PMC3263702 DOI: 10.1155/2012/647256] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 08/11/2011] [Indexed: 11/17/2022] Open
Abstract
The sellar and parasellar (SPS) region is a complex area rich in vital neurovascular structures and as such may be the location of first manifestation of a systemic malignancy. Metastases to this region are rare; breast cancer is the most common source among those that metastasize to the SPS region. Ophthalmoplegia, headache, retroorbital or facial pain, diabetes insipidus, and visual field defects are the most commonly reported symptoms. Lack of specific clinical and radiological features renders SPS metastases difficult to differentiate from the other frequently encountered lesions in this area, especially when there is no known history of a primary disease. Currently accepted management is multimodality therapy that includes biopsy and/or palliative surgical resection, radiation, and chemotherapy. Although no significant survival benefits have been shown by the surgical series, surgical resection may improve quality of life. Here we review the relevant literature and present six illustrative cases from our own institution.
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Kramer CK, Ferreira N, Silveiro SP, Gross JL, Dora JM, Azevedo MJD. Pituitary gland metastasis from renal cell carcinoma presented as a non-functioning macroadenoma. ACTA ACUST UNITED AC 2011; 54:498-501. [PMID: 20694412 DOI: 10.1590/s0004-27302010000500011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Accepted: 03/29/2010] [Indexed: 11/21/2022]
Abstract
Metastatic tumors involving the pituitary gland are an uncommon finding and occur in up to 1% of all pituitary tumor resections. A 74-year-old man had progressive vision deterioration, over the 30 days prior to consultation. He did not complain of headache or polyuria, but referred to intestinal constipation. Five years ago, he underwent a right radical nephrectomy for renal cell carcinoma, followed by chemotherapy and radiotherapy for lung and parotid metastases. On ophthalmologic examination, there was a left abducens nerve palsy and bitemporal hemianopia. Magnetic resonance imaging demonstrated a sellar mass with suprasellar cistern extension compressing the optic chiasm. Endocrinological evaluation revealed central adrenal and gonadal insufficiencies. The patient underwent a transsphenoidal tumor resection that revealed renal cell carcinoma. This case illustrates that metastatic pituitary lesions can mimic typical symptoms and signs of pituitary macroadenoma. Furthermore, clinical diabetes insipidus, a common finding of pituitary metastases, can be absent.
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Affiliation(s)
- Caroline Kaercher Kramer
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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11
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Peppa M, Papaxoinis G, Xiros N, Hadjidakis D, Raptis SA, Economopoulos T. Panhypopituitarism due to Metastases to the Hypothalamus and the Pituitary Resulting From Primary Breast Cancer: A Case Report and Review of the Literature. Clin Breast Cancer 2009; 9:E4-7. [DOI: 10.3816/cbc.2009.n.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Subías MC, Orduña VA, Guevara RGLD, Martínez ARDL, Hernández TP, Torres AA. Diabetes insípida central como primera manifestación clínica de un carcinoma colorrectal metastásico. Clin Transl Oncol 2004. [DOI: 10.1007/bf02712385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Piedra MP, Brown PD, Carpenter PC, Link MJ. Resolution of diabetes insipidus following gamma knife surgery for a solitary metastasis to the pituitary stalk. J Neurosurg 2004; 101:1053-6. [PMID: 15597769 DOI: 10.3171/jns.2004.101.6.1053] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ The authors present the case of a 58-year-old woman who presented with symptoms of diabetes insipidus (DI) 1 year after she was found to have a Stage 3 (of 4) estrogen receptor—positive infiltrating ductal adenocarcinoma of the left breast with pulmonary and bone metastases. Magnetic resonance images demonstrated a solitary site of metastasis in the patient's pituitary stalk, and gamma knife surgery (GKS) was performed to treat the lesion. Three months after GKS the patient was able to reduce the medication she required for the DI. There was no evidence of pituitary failure and no negative effect on her vision.
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Affiliation(s)
- Mark P Piedra
- Mayo Medical School, Division of Radiation Oncology and Endocrinology, Rochester, Minnesota 55905, USA
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14
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Abstract
Only 1% of all pituitary surgeries are performed to treat tumors that have metastasized to the pituitary gland; however, in certain cases of malignant neoplasms pituitary metastases do occur. Breast and lung cancers are the most common diseases that metastasize to the pituitary. Breast cancer metastasizes to the pituitary especially frequently, with reported rates ranging between 6 and 8% of cases.Most pituitary metastases are asymptomatic, with only 7% reported to be symptomatic. Diabetes insipidus, anterior pituitary dysfunction, visual field defects, headache/pain, and ophthalmoplegia are the most commonly reported symptoms. Diabetes insipidus is especially common in this population, occurring in between 29 and 71% of patients who experience symptoms.Differentiation of pituitary metastasis from other pituitary tumors based on neuroimaging alone can be difficult, although certain features, such as thickening of the pituitary stalk, invasion of the cavernous sinus, and sclerosis of the surrounding sella turcica, can indicate metastasis to the pituitary gland. Overall, neurohypophysial involvement seems to be most prevalent, but breast metastases appear to have an affinity for the adenohypophysis. Differentiating metastasis to the pituitary gland from bone metastasis to the skull base, which invades the sella turcica, can also be difficult. In metastasis to the pituitary gland, surrounding sclerosis in the sella turcica is usually minimal compared with metastasis to the skull base.Treatment for these tumors is often multimodal and includes surgery, radiation therapy, and chemotherapy. Tumor invasiveness can make resection difficult. Although surgical series have not shown any significant survival benefits given by tumor resection, the patient's quality of life may be improved. Survival among these patients is poor with mean survival rates reported to range between 6 and 22 months.
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Huinink DT, Veltman GA, Huizinga TW, Roelfsema F, Keizer HJ. Diabetes insipidus in metastatic cancer: two case reports with review of the literature. Ann Oncol 2000; 11:891-5. [PMID: 10997822 DOI: 10.1023/a:1008319027651] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D T Huinink
- Department of Clinical Oncology, Leiden University Medical Center, The Netherlands.
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Poullin P, di Costanzo V, Le Pommelet C, Gabriel B. [Diabetes insipidus disclosing metastasis of breast adenocarcinoma]. Rev Med Interne 1995; 16:444-6. [PMID: 7652228 DOI: 10.1016/0248-8663(96)80737-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We are reporting on a case of diabetes insipidus (DI) and anterior pituitary failure revealing a breast cancer metastasis. Ten years after being diagnosed with a unilateral breast cancer, the patient presented with asthenia, thirst, polyuria and nocturia improved by subcutaneous DDAVP. MRI revealed a thickened pituitary stalk. DI is uncommon, late and usually asymptomatic in breast cancer. The association with an anterior pituitary failure is even more rare. In our patient the metastasis is in the pituitary stalk and seems to be due to meningeal deposits. MRI appears to be the best procedure to perform, showing a thickening stalk. Extension to the pituitary gland is related to direct tumor invasion from adjacent structures rather than haematogenous spread.
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Affiliation(s)
- P Poullin
- Service de médecine interne, CHU La Conception, Marseille, France
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