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J Clin Endocrinol Metab. 2019 Aug 1;104(8):3379-3388. doi: 10.1210/jc.2019-00012.

Pituitary Metastases: A Nationwide Study on Current Characteristics With Special Reference to Breast Cancer.

Author information

1
Department of Endocrinology, Skåne University Hospital, Lund University, Malmö, Sweden.
2
Centre for Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden.
3
Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
4
Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.
5
Institute of Molecular Medicine and Surgery, Karolinska Institute and Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden.
6
Department of Medical Sciences, Endocrinology and Mineral Metabolism, Uppsala University, Uppsala, Sweden.
7
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
8
Department of Endocrinology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
9
Department of Genetics and Pathology, Labmedicine, Medical Service, Skåne University Hospital, University of Lund, Lund, Sweden.

Abstract

OBJECTIVE:

To investigate the contemporary presentation of pituitary metastases.

PATIENTS:

Thirty-eight patients diagnosed with pituitary metastases from 1996 to 2018 in Sweden.

METHODS:

Pituitary metastases were confirmed by histopathology (n = 27) or considered highly likely according to radiological findings, including rapid tumor progression (n = 11). Medical records were reviewed and sellar images reexamined centrally.

RESULTS:

Breast and lung cancers were the most common primary tumors, in 45% and 21% of patients, respectively. Sixty-seven percent of breast cancers overexpressed human epidermal growth factor receptor 2 (HER2); 53% of pituitary metastases from breast cancers appeared ≥10 years after diagnosis of the primary tumor. At presentation, 71% appeared to have ACTH deficiency, 65% had TSH deficiency, and 26% had diabetes insipidus. Fatigue, nausea/vomiting, loss of appetite, weight loss, myalgia, and/or arthralgia were reported in 47% of patients with morning cortisol <100 nmol/L vs 23% with cortisol ≥200 nmol/L. Sixteen patients had visual field defects, and eight had diplopia. Intrasellar and suprasellar tumor growth was the most frequent finding. Initially, a pituitary adenoma was considered the etiology in 18% of patients.Radiotherapy, pituitary surgery, and chemotherapy were used in 68%, 68%, and 11% of patients, respectively. One and 2 years after diagnosis of pituitary metastases, 50% and 26% of patients were alive.

CONCLUSION:

Pituitary metastases may be mistaken for pituitary adenomas and can appear late, especially in breast cancer. Breast cancers overexpressing HER2 seem prone to metastasize to the pituitary. Hypocortisolism may be misdiagnosed as cancer-related malaise. An increased awareness of pituitary metastases and undiagnosed pituitary failure can improve management in these patients.

PMID:
30892659
DOI:
10.1210/jc.2019-00012

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