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Tumors metastatic to the pituitary gland: case
report and literature review
Komninos J, Vlassopoulou V, Protopapa D, Korfias S, Kontogeorgos G, Sakas DE,
Thalassinos NC
Department of Endocrinology, Diabetes and Metabolism,
Evangelismos General Hospital, 10676 Athens, Greece. jokomni@otenet.gr
Tumors metastatic to the pituitary gland are an unusual complication of systemic
cancer typically seen in elderly patients with diffuse malignant disease.
Breast and lung are the commonest sites of the primary tumor, whereas diabetes
insipidus is the most frequent symptom at presentation.
Their rarity and usually indolent course, as well as the lack of specific
clinical and radiological features, impede their differentiation from other more
common sellar area lesions, particularly when history of malignancy is
absent.
Management of these patients may also be very difficult because the prognosis
depends on the course of the primary neoplasm.
A 68-yr-old man, with no history of malignancy, presented with recent onset of
hypopituitarism, mild diabetes insipidus, headaches, left oculomotor nerve
palsy, and progressive bilateral deterioration of visual acuity and visual
fields.
Magnetic resonance imaging revealed a large sellar mass compressing the optic
chiasm and invading the left cavernous sinus, whereas a prolactin elevation at
438.6 ng/ml (19.73 nmol/liter) was noted.
Decompression of the sellar region was attempted, and pathology disclosed a
metastatic hepatocellular carcinoma.
On postoperative investigation, primary liver tumor was identified and confirmed
by biopsy.
The patient improved transiently but died 3 months after diagnosis because of
deterioration of the liver disease.
The relevant literature is reviewed in light of this unusual case, illustrating
the problems in the diagnosis and management of patients with metastasis to the
pituitary.
PMID: 14764764 [PubMed - indexed for MEDLINE]
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