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Surgical management of pituitary metastases

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Abstract

Background

Pituitary metastases are rare and commonly described in case reports or small case series. Due to its rarity this entity is not subject to standardized treatment guidelines, there is debate about typical initial symptoms that may lead to finding the correct diagnosis and information about the clinical course is also sparse.

Methods

We have conducted a retrospective analysis of patients with pituitary metastases who were surgically treated via a transsphenoidal procedure at our institution between 2006 and 2014. Underlying primary disease, clinical and surgical course as well as adjuvant radiotherapy and follow-up data are presented.

Results

14 patients met the inclusion criteria (8 female, 6 male). Mean age was 61.5 years. Most patients became symptomatic with visual symptoms—both visual deterioration and/or diplopia (n = 13)—and anterior lobe insufficiency (n = 8). Surprisingly diabetes insipidus was only seen in three patients. All patients underwent transsphenoidal surgery initially, four patients had to undergo surgery for residual tumor or recurrence, two of them via a transcranial route. Breast cancer was the most common entity (n = 6), followed by prostate cancer (n = 3), nsclc (n = 2) and melanoma, thyroid cancer and renal cancer in one case each. Postoperative MRI showed gross total resection in four cases and residual disease in eight cases (subtotal resection, partial resection and biopsy), two patients files were incomplete regarding MRI-results. All patients underwent adjuvant radiotherapy. Survival after the initial diagnosis of cancer was 36 and 16 months after diagnosis of pituitary metastases.

Conclusion

Our results indicate that transsphenoidal surgery is a safe method to resect pituitary metastases and that the extend of resection does not have an influence on survival time. Our results also indicate that diabetes insipidus may not be the most common initial symptom of pituitary metastases and lack thereof should not lead to making a wrong diagnosis and delaying appropriate therapy.

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Acknowledgments

The authors would like to thank Dr. Jakob Matschke at the Hamburg University, Institute of Neuropathology for his support.

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    Authors and Affiliations

    1. Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

      T. Burkhardt, M. Henze, M. Westphal, N. O. Schmidt & J. Flitsch

    2. Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

      L. A. Kluth

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    1. T. Burkhardt
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    Correspondence to T. Burkhardt.

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    T. Burkhardt and M. Henze have contributed equally to this work.

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    Burkhardt, T., Henze, M., Kluth, L.A. et al. Surgical management of pituitary metastases. Pituitary 19, 11–18 (2016). https://doi.org/10.1007/s11102-015-0676-z

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