Endocrine Abstracts (2019) 65 P295 | DOI: 10.1530/endoabs.65.P295

Review of pituitary metastases diagnosed in a large pituitary centre

Kirstie Lithgow1,2,3, Izel Siqueira1,2,3, John Ayuk1,2, Andrew Toogood1,2, Neil Gittoes1,2, Latha Senthil4, Han Seng Chew4, Swarupsinh Chavda4, Tim Matthews5, Ruchika Batra5, Shahzada Ahmed6, Neelam Khan6, Sara Meade7, Paul Sanghera7, Alex Paluzzi8, George Tsermoulas8 & Niki Karavitaki1,2,3


1Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 2Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; 3Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; 4Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 5Department of Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 6Department of Ear, Nose, Throat, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 7Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 8Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK


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.