Background: Metastatic disease in the pituitary (PM) is uncommon and the published literature mainly involves case reports and small case series. We aimed to analyze presenting manifestations and outcomes of patients diagnosed with PM in our pituitary centre.
Methods: Retrospective review of our Pituitary Registry to identify patients with PM from 2006 to present. Clinical, radiological, and pathological data were collected and analysed.
Results: We identified 19 patients (13 F) with the diagnosis of PM. 8 had histologically proven PM and the others were diagnosed clinically. The presenting manifestations were visual dysfunction (cranial nerve palsies or visual fields compromise) in 8 patients, hypoadrenalism in 2, diabetes insipidus (DI) in one, and headache in one; in 7 patients, PM was detected on imaging without associated clinical manifestations. Twelve patients were diagnosed with hypopituitarism at presentation, though only 3 had DI. The majority of patients (n=13) had a known diagnosis of malignancy at the time of PM detection (median time between primary malignancy and PM diagnoses 29 months, range 10−240). The most common primary malignancies were lung (n=7) and breast (n=6); prostate (n=2), melanoma (n=2), glioblastoma (n=1), and renal carcinoma (n=1) were the remaining tumours. Management strategies for the PM included radiotherapy (n=8), surgery and radiotherapy (n=4), surgery alone (n=3) or monitoring (n=4). One-year survival following PM diagnosis was 42%.
Discussion/conclusions: PM has variable clinical presentation. Some findings from our series differ from previous literature. We report several asymptomatic PMs detected on imaging. Most patients had evidence of hypopituitarism, but DI was relatively uncommon. Although, PM has previously been considered a manifestation of end-stage malignancy associated with very short life expectancy, one-year survival in our series was higher than reported in most previous literature, possibly reflecting improvements in the management of the primary cancer.