alexa Symptomatic Metastasis to the Pituitary Gland: A Report of Three Cases and Review of the Literature | OMICS International | Abstract
ISSN: 2329-6895

Journal of Neurological Disorders
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Case Report

Symptomatic Metastasis to the Pituitary Gland: A Report of Three Cases and Review of the Literature

Peter YM Woo1*, Ronald Li1, Yung Chan1, Timothy SK Chan2, Peter KH Pang1, Kwong-Yau Chan1 and John CK Kwok1
1Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China
2Department of Pathology, Kwong Wah Hospital, Hong Kong, China
Corresponding Author : Peter YM Woo
Hong Kong Room 318 Nursing Quarters
Kwong Wah Hospital, 25 Waterloo Road, Hong Kong
Tel: 3517 5052
Fax: 3517 5260
E-mail: [email protected]
Received May 09, 2015; Accepted June 08, 2015; Published June 14, 2015
Citation: Peter YMW, Ronald L, Yung C, Timothy SKC, Peter KHP, et al. (2015) Symptomatic Metastasis to the Pituitary Gland: A Report of Three Cases and Review of the Literature. J Neurol Disord 3:236. doi: 10.4172/2329-6895.1000236
Copyright: © 2015 Peter YMW, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Abstract

Objective and importance: Symptomatic metastases to the pituitary gland are rare and often herald advanced systemic malignant disease. Distinguishing them from benign pituitary adenomas is challenging. The clinicoradiological features of three patients with pituitary metastases are presented. We also review the literature from 1970 to 2015 to formulate a diagnostic strategy. Clinical presentation: All patients were elderly with ages ranging from 65 to 82 years old. One had a previously undiagnosed prostatic carcinoma and two had known histories of primary gastric or parotid salivary gland carcinoma. Rapid visual deterioration was the most common symptom followed by ophthalmoplegia. Cranial diabetes insipidus (CDI) was observed after administrating hydrocortisone replacement in one patient. All patients had evidence of a solitary pituitary tumor on magnetic resonance imaging (MRI) of which two had discernible posterior pituitary signal changes. Trans-sphenoidal excision was performed for all patients with no procedure related complications. Two patients had visual improvement, but due to advanced systemic disease all succumbed within two months. A literature review of 475 pituitary metastases revealed that breast (37.1%) and bronchogenic carcinomas (22.1%) were the most frequently encountered primary malignancies. Among 290 symptomatic patients (22.1%) were the most frequently encountered primary malignancies. Among 290 symptomatic patients the commonest presentation was CDI (19.9%) and 12.1% had ophthalmoplegia. Of the 166 tumors with documented neuroimaging features, 31.3% had evidence of pituitary stalk thickening or enhancement followed by cavernous sinus invasion (30.1%) or was dumbbell shaped (27.7%). Conclusion: Diagnosing metastatic pituitary tumors is important for the treating clinician in order to avoid unnecessary surgical excision in patients with limited life expectancy. Patients older than 60 years, or with a history of cancer, presenting with CDI or ophthalmoplegia are red flag clinical features. For these patients we recommend investigations for occult primary malignancy when early posterior pituitary involvement orcavernous sinus invasion is demonstrated on MRI.

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