P Sioutos1, V Yen, E Arbit. 1. Neurosurgery Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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. METHODS: 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.
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. METHODS: 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.