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Endocrine Abstracts (2013) 31 P158 | DOI: 10.1530/endoabs.31.P158

King’s College Hospital, London, UK.

Background: Pituitary metastases are a rare complication of systemic malignancy. The most common presentations of pituitary masses include visual field defects, headaches, and hypopituitarism, but cranial nerve palsies and diabetes insipidus are also recognised although unusual. We aimed to determine if these were more frequently associated with pituitary metastasis.

Methods: We conducted a review of 944 patients undergoing pituitary surgery from a teaching hospital neuropathology database 1997–2012, identifying histologically confirmed pituitary metastasis or deposit from haematological malignancy. We reviewed symptoms at presentation, including diabetes insipidus, cranial nerve palsies and anterior pituitary hormonal deficiencies. In addition, we recorded the site of primary tumour.

Results: We identified 11 cases of metastatic pituitary lesions, representing 1.16% of all surgical biopsies performed. Breast and lung cancer were the most common primary neoplasms metastasising to the pituitary (36.3 and 27.3% respectively). The remaining neoplasms metastasising to the pituitary were liver and kidney cancer, and haematological malignancies including myeloma and B-cell lymphoma. The most common presentation was headache and visual field defects. However, 63.6% of patients presented with anterior pituitary deficiencies, 54.4% with cranial nerve palsies, and 27.2% with diabetes insipidus. Primary pituitary presentations occurred in 45.4% of cases prior to a diagnosis of malignancy. In cases where there was a known history of malignancy, the mean time between diagnosis of primary tumour and the onset of pituitary symptoms was 26 months (SE=12.3, n=6) with a median of 15 months.

Conclusion: Cranial nerve palsies and diabetes insipidus are highly unusual in patients with pituitary adenoma and should alert clinicians to consider and investigate for pituitary metastasis in patients with or without a previous diagnosis of neoplastic disease.

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