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

Research output: Contribution to journalArticle

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.

Details

Authors
Organisations
External organisations
  • Skåne University Hospital
  • Sahlgrenska Academy
  • Sahlgrenska University Hospital
  • Karolinska University Hospital
  • Uppsala University
  • Umeå University
  • Linköping University
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cancer and Oncology
Original languageEnglish
Pages (from-to)3379-3388
Number of pages10
JournalJournal of Clinical Endocrinology and Metabolism
Volume104
Issue number8
Publication statusPublished - 2019 Aug
Publication categoryResearch
Peer-reviewedYes