Endocrine Abstracts

Introduction: Pituitary metastases are rare, accounting for only 1% of intracranial metastases and predominantly originating from breast and lung tumors. Pituitary involvement is observed in only 6–8% of breast cancer cases, with an overall unfavorable prognosis.

Case series: A 53-year-old woman, with a six-year history of breast cancer metastasized to the lungs, presented with a three-month history of headaches, visual disturbances, asthenia, weight loss and polyuria. Head MRI revealed a 20mm lesion in the sellar and suprasellar region, causing obliteration of the suprasellar cistern and compression of the optic chiasm and third ventricle. Assessment of pituitary function revealed low levels of 0800 hours cortisol (0.5 mg/dl), FT4 (0.2 ng/dl), FSH (5.8 IU/l) and LH (<0.07 IU/l), and low urine density. Treatment included hydrocortisone 20 mg, levothyroxine 50 μg and desmopressin 0.06 mg. No visual field changes were observed. Transsphenoidal surgery confirmed pituitary metastasis, and she died shortly after due to advancing systemic disease. A 46-year-old woman recently diagnosed with breast cancer presented with dizziness, nausea, somnolence, blurry vision, asthenia, weight loss, and polyuria. Assessment of pituitary function showed low levels of 0800 hours cortisol (0.8 mg/dl), FT4 (0.44 ng/dl) and IGF-1 (37.3 ng/ml). Additionally, she exhibited low urine osmolality (260 mOsm/kg) and a high serum sodium concentration. Head MRI showed a 26mm sellar and suprasellar lesion, obliterating the cisterna and compressing the third ventricle and optic chiasm. Treatment included hydrocortisone 15 mg, levothyroxine 75 μg, and desmopressin 0.06 mg. She died a few months later from disease progression. A 61-year-old woman, with a six-year history of breast carcinoma and subsequent metastatic progression to the liver, bones, lungs, and mediastinal lymph nodes, presented with headache, vomiting, disinhibition, dysarthria, and diplopia. Neurological examination revealed bilateral dysmetria, ataxia, and left lateral rectus paresis. Laboratory tests revealed low levels of FT4 (0.58 ng/dl), FT3 (0.59 pg/ml), FSH (<0.3 IU/l), LH (<0.07 IU/l) and IGF-1 (52.1 ng/ml). Head MRI revealed left cerebellar and pituitary metastases with optic chiasm compression. Treatment included levothyroxine 100 µg, palliative hormonal therapy, and whole-brain radiotherapy. She died two years later due to neoplastic disease progression.

Conclusion: While pituitary metastases are rare, they should be considered in the differential diagnosis when there is evidence of pituitary involvement in malignant disease. Despite the devastating impact on a patient’s survival prognosis, significant potential for symptom relief exists, emphasizing the crucial need for high clinical suspicion for prompt identification and management.