Pituitary metastases: a case series and scoping review

Pituitary - Tập 26 - Trang 538-550 - 2023
Kaiyun Yang1,2, Sabrina L. Begley2, Daniel Lynch2, Vincent Ye1, Jasleen Saini1, Enrique Gutierrez3, Jaclyn Vialet4, Barbara-Ann Millar3, Tatianna Conrad3, Normand Laperriere3, Mark Bernstein1, Gelareh Zadeh1, David B. Shultz3, Paul N. Kongkham1
1Department of Neurosurgery, University of Toronto, Toronto, Canada
2Department of Neurosurgery, Northwell Health, Manhasset, USA
3Department of Radiation Oncology, University of Toronto, Toronto, Canada
4Medical Library, North Shore University Hospital, Manhasset, USA

Tóm tắt

To understand the natural history and optimal treatment strategy for pituitary gland metastasis. We performed both a retrospective chart review of patients treated at our institution and a scoping review of the topic. The retrospective review identified seven patients with an average age of 59.6 years. Primary histologies included breast cancer (4), melanoma (1), renal cell carcinoma (1), and sarcoma (1). Two patients had anterior pituitary endocrine dysfunction, one of whom was the only patient with visual symptoms. All patients were treated with radiosurgery and two also underwent surgical resection. Overall survival ranged from 6.5 to 117 months. Literature review identified 166 patients from 71 studies. The most common primary cancer was lung (27.7%), followed by breast (18.7%) and renal (14.5%) cancer. 107 presented with endocrine dysfunction, including 41 cases of diabetes insipidus and 55 cases of hypopituitarism. 110 presented with visual compromise. 107 patients received radiotherapy, 96 underwent surgical resection and 44 received systemic chemotherapy/immunotherapy. Surgery was significantly associated with an increased likelihood of vision improvement and a decreased likelihood of endocrine normalization. Radiographic regression predicted visual improvement. Median overall survival was 9.9 months (range: 0.2–96). This scoping review showed that both radiosurgery and surgical resection have been frequently used to treat pituitary metastases with good response. Vision improvement is more likely to happen following surgical resection, likely at the expense of endocrine dysfunction. Despite treatment and radiographic response, patient survival remains less than a year.

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