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

Schill, Fredrika LU ; Nilsson, Margareta ; Olsson, Daniel S. ; Ragnarsson, Oskar ; Berinder, Katarina ; Edén Engström, Britt ; Dahlqvist, Per ; Wahlberg, Jeanette ; Englund, Elisabet LU and Burman, Pia LU (2019) In Journal of Clinical Endocrinology and Metabolism 104(8). p.3379-3388
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... (More)

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.

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published
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in
Journal of Clinical Endocrinology and Metabolism
volume
104
issue
8
pages
10 pages
publisher
Oxford University Press
external identifiers
  • scopus:85068577177
  • pmid:30892659
ISSN
0021-972X
DOI
10.1210/jc.2019-00012
language
English
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yes
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56d43678-ecd0-4cdd-a0f2-83aae38253b3
date added to LUP
2019-07-17 09:05:25
date last changed
2020-08-05 05:28:45
@article{56d43678-ecd0-4cdd-a0f2-83aae38253b3,
  abstract     = {<p>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 &lt;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.</p>},
  author       = {Schill, Fredrika and Nilsson, Margareta and Olsson, Daniel S. and Ragnarsson, Oskar and Berinder, Katarina and Edén Engström, Britt and Dahlqvist, Per and Wahlberg, Jeanette and Englund, Elisabet and Burman, Pia},
  issn         = {0021-972X},
  language     = {eng},
  number       = {8},
  pages        = {3379--3388},
  publisher    = {Oxford University Press},
  series       = {Journal of Clinical Endocrinology and Metabolism},
  title        = {Pituitary Metastases : A Nationwide Study on Current Characteristics with Special Reference to Breast Cancer},
  url          = {http://dx.doi.org/10.1210/jc.2019-00012},
  doi          = {10.1210/jc.2019-00012},
  volume       = {104},
  year         = {2019},
}