Pituitary metastases

Abstract

Introduction: Metastatic disease of the pituitary is an uncommon clinical problem, although autopsy findings on patients who die of disseminated carcinoma suggest that it occurs more frequently than is clinically evident. Pituitary metastases are often difficult to distinguish from pituitary adenomas both clinically and radiologically. Materials and Methods: Between 1967 and 2001 six patients with histologically proven pituitary metastases were treated surgically by the Division of Neurosurgery at Groote Schuur Hospital. Results: The mean age of patients was 55.5 years. Four patients had carcinoma of the lung, 1 of the breast and 1 'epithelial'. Clinical presentation included headaches (3 patients), visual deficits (4 patients) and ophthalmoplegia (3 patients). No endocrine dysfunction was found. Radiological investigation was non-specific. The patients all had palliative improvement following surgery but the prognosis was poor with an average survival of 7 months. Conclusion: Pituitary metastasis is an uncommon diagnosis, the most common primary cancers being breast and lung. The clinical and radiological diagnosis is usually non-specific although diabetes insipidus in a patient with a known malignancy may raise the suspicion. The treatment whether surgical or radiotherapy offers good palliation of symptoms, but the outcome is determined by the metastatic disease and is poor.