This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Komninos, J. Articles by Thalassinos, N. C. Search for Related Content PubMed PubMed Citation Articles by Komninos, J. Articles by Thalassinos, N. C.

Tumors Metastatic to the Pituitary Gland: Case Report and Literature Review

Departments of Endocrinology, Diabetes and Metabolism (J.K., V.V., N.C.T.) and Pathology (D.P.), Evangelismos General Hospital, 10676 Athens; Department of Neurosurgery, University of Athens (S.K., D.S.), Evangelismos General Hospital, 10676 Athens; and Department of Pathology (G.K.), G. Gennimatas Athens General Hospital, 11527 Athens, Greece

Address all correspondence and requests for reprints to: Dr. John Komninos, Department of Endocrinology, Diabetes and Metabolism, Evangelismos General Hospital, 45-47 Ipsilantou Street, 10676 Athens, Greece. E-mail: jokomni{at}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.

Abbreviations: CT, Computer tomography; HCC, hepatocellular carcinoma; MP, metastasis to the pituitary; MRI, magnetic resonance imaging; PRL, prolactin; T1WI, T1-weighted image(s); T2WI, T2-weighted image(s); TSS, transsphenoidal surgery.

This article has been cited by other articles:

				G. A Kaltsas, J. Evanson, A. Chrisoulidou, and A. B Grossman The diagnosis and management of parasellar tumours of the pituitary Endocr. Relat. Cancer, December 1, 2008; 15(4): 885 - 903. [Abstract] [Full Text] [PDF]

				G. Minniti, V. Esposito, M. Piccirilli, A. Fratticci, A. Santoro, and M.-L. Jaffrain-Rea Diagnosis and management of pituitary tumours in the elderly: a review based on personal experience and evidence of literature Eur. J. Endocrinol., December 1, 2005; 153(6): 723 - 735. [Abstract] [Full Text] [PDF]

				G. A. Kaltsas, P. Nomikos, G. Kontogeorgos, M. Buchfelder, and A. B. Grossman Diagnosis and Management of Pituitary Carcinomas J. Clin. Endocrinol. Metab., May 1, 2005; 90(5): 3089 - 3099. [Abstract] [Full Text] [PDF]