To characterize the clinical presentation, endocrine phenotype, and outcomes of pituitary metastasis in a contemporary tertiary-center cohort, with emphasis on clinically actionable diagnostic red flags. We conducted a retrospective single-center case series of 14 consecutive patients diagnosed with pituitary metastasis between 2010 and 2025. Presenting manifestations, endocrine features, radiologic findings, primary tumor origin, treatment patterns, and overall survival were assessed. In patients without histopathologic confirmation, diagnosis was established using the validated clinicoradiologic model proposed by Yuzkan et al. RESULTS: Median age was 52.5 years, and 71.4% of patients were women. Hypopituitarism (64.3%), arginine vasopressin deficiency (50.0%), and visual impairment (50.0%) were frequent at presentation. One patient presented with sudden bilateral visual loss and hemodynamic instability, mimicking an apoplexy-like sellar emergency. Breast cancer was the most common primary tumor (28.6%). Serum prolactin levels, available in 11 patients, were uniformly below the range typically expected for macroprolactinoma despite large sellar masses. Histopathologic confirmation was obtained in 35.7% of cases, whereas the remainder fulfilled high-likelihood clinicoradiologic criteria. Median overall survival after pituitary metastasis diagnosis was 6.5 months, and 92.9% of patients died during follow-up. Pituitary metastasis frequently presents with combined endocrine dysfunction and neuro-ophthalmologic compromise, occasionally as an acute sellar emergency. In oncologic patients with sellar lesions, the combination of AVP-D, visual deterioration, and non-prolactinoma-range hyperprolactinemia should raise suspicion for pituitary metastasis and prompt urgent endocrine and local evaluation.

Pituitary metastases (PM) are rare intracranial secondary tumors, most often arising from breast and lung primaries. They are clinically significant due to their association with advanced systemic malignancy and potential to cause visual, neurological, and endocrinological morbidity. Conventional therapies such as surgery and fractionated radiotherapy have limited efficacy or high morbidity. Stereotactic radiosurgery (SRS) has emerged as a minimally invasive alternative, but available evidence is limited to small, heterogeneous series. To evaluate the effectiveness and safety of SRS in patients with PM by synthesizing data on tumor control, survival outcomes, progression-free survival (PFS), and treatment-related morbidity. A systematic review and meta-analysis were performed according to PRISMA guidelines. PubMed, Embase, Scopus, Web of Science, and Cochrane Library were searched through June 2025. Eligible studies included patients with radiologically or histologically confirmed PM treated with SRS. Outcomes of interest were local tumor control, survival, PFS, radiological response, and complications, including hypopituitarism, optic neuropathy, and radiation necrosis. Data were pooled using a random-effects single-arm meta-analysis model. Six retrospective case series comprising 142 patients were included. Pooled local control following SRS was 89% (95% CI 75-96%). Six-month PFS was 97% (95% CI 83-100%). One- and two-year survival rates were 53% (95% CI 32-73%) and 40% (95% CI 15-72%), respectively. Tumor regression occurred in 34% and stable disease in 33%, while only 7% demonstrated progression. Treatment-related morbidity was low: new-onset hypopituitarism (1%), optic neuropathy (2%), and radiation necrosis (1%). SRS provides effective and durable local control of pituitary metastases with a favorable safety profile and low rates of treatment-related toxicity. Despite the poor systemic prognosis associated with PM, SRS offers meaningful intracranial disease control and symptom relief, particularly in well-selected patients with stable systemic disease. Larger prospective, standardized studies are needed to further clarify long-term endocrine and neurological outcomes.

The pituitary gland is an uncommon site of tumor metastasis and is predominantly associated with malignancies of the lung and breast. Metastatic involvement of the pituitary gland in lung cancer (LC) typically indicates advanced disease and is associated with poor prognosis and pituitary insufficiency, which often remains underdiagnosed and significantly affects quality of life and survival. We present four cases of pituitary metastasis (PM) originating from LC, characterized by distinct histological subtypes, variable timing from initial diagnosis, and diverse clinical manifestations. Clinical presentation was heterogeneous: two patients had involvement of both pituitary lobes with multiple pituitary hormone deficiencies, one had anterior lobe involvement with anterior pituitary deficiency following immune checkpoint inhibitor-associated hypophysitis, and one remained asymptomatic. Therapeutic approaches included partial surgical resection followed by radiotherapy in two patients and radiotherapy alone in the other two; all patients continued systemic antineoplastic therapy and received hormone replacement as indicated. Mean overall survival was 7.5 months. PM can occur across all histological subtypes of LC and typically signifies advanced disease with poor prognosis. Early identification and appropriate management of hypopituitarism may improve quality of life and clinical outcomes.

Metastasis to the pituitary gland is rare, occurring in approximately 1% of pituitary tumors resected via transsphenoidal surgery. We present the second report of metastatic high-grade serous ovarian carcinoma to the pituitary gland, presenting with diabetes insipidus and bilateral hemianopsia. An 86-year-old female patient presented with complaints of dizziness, vertigo, vision changes (peripheral field vision loss), loss of taste, extreme thirst, and fatigue. Urine studies revealed hypotonic hyponatremia, which was consistent with diabetes insipidus. The pituitary magnetic resonance imaging (MRI) scan revealed a sellar and suprasellar hypoenhancing lesion compressing the optic chiasm. The intrasellar portion was heterogeneous, whereas a nodular component along the stalk demonstrated more solid, mild enhancement. The lesion measured 1.8 cm craniocaudally and 7 mm medial-laterally. The lesion presented with compression on the optic chiasm and edema in the proximal optic tracts and hypothalamus. This was a new finding compared with the MRI of the cervical spine as well as prior head computed tomography. An endoscopic transsphenoidal approach to resect the sellar and suprasellar parts of the lesion was performed. Pathology results revealed metastatic adenocarcinoma to the anterior pituitary gland with large areas of necrosis. Immunohistochemistry results revealed that the tumor cells were positive for pankeratin, keratin 7, PAX8, WT1, and estrogen receptor with null-type tumor protein p53 labeling, and negative for keratin 20, TTF1, Napsin-A, GATA3, CDX2, synaptophysin, chromogranin, p16, p63, KIT, and progesterone receptor. The final diagnosis was metastatic adenocarcinoma of Mullerian origin. Following diagnosis, a metastatic workup was done, including a whole-body positron emission tomography (PET) scan, which revealed a 5.1 cm right adnexal ovoid mass and numerous scattered liver metastases. Additionally, the PET scan revealed hypermetabolic right supraclavicular, paratracheal, celiac, and upper aortocaval nodes, consistent with metastatic disease. This report highlights high-grade serous ovarian carcinoma with pituitary metastasis as the initial presentation of systemic cancer.

The challenges of a rapidly progressive pituitary metastasis

IntroductionPituitary metastasis from a solid tumour is an extremely rare condition and is generally associated with a poor prognosis. Spontaneous regression is not typically expected, which further worsens the outlook. Here, we present a case of a patient with small-cell lung cancer (SCLC) who developed a pituitary mass. The marked regression of the lesion following chemotherapy strongly supported the likelihood of pituitary metastasis in this case.Clinical CaseA 59-year-old female patient, diagnosed with SCLC one month ago, was receiving radiotherapy and she also had a chemotherapy plan. When visual impairment and ptosis developed, cranial MRI was performed. She was referred to our outpatient clinic due to pituitary lesion. On physical examination blood pressure was 130/70 mmHg and a heart rate was 92/min. She was mildly dyspneic, had no signs of endocrine hyperfunction, nor polyuria or polydipsia. Obesity was also noted. Her medical history included hypertension and ischemic heart disease. In laboratory examination;ParameterResultReference RangeNa⁺140 mmol/L135–145 mmol/LK⁺4.9 mmol/L3.5–5.0 mmol/LBasal Cortisol30.3 μg/dL6.2–19.4 μg/dLACTH164 ng/L7.2–63.3 ng/LIGF-1471 μg/L62–186 μg/LTSH1.52 mIU/L0.27–4.8 mIU/LfT41.26 ng/dL0.79–1.59 ng/dLFSH9.6 IU/L3.5–12.6 IU/LLH4.08 IU/L2.4–12.6 IU/LProlactin20.3 μg/L2.8–29.2 μg/L1 mg Dexamethasone Suppression Test (DST)15.7 μg/dL—4 mg Dexamethasone Suppression Test (DST)18 μg/dL—Liver and Renal FunctionsNormal—Pituitary MRI revealed a 17×15×12 mm suprasellar mass lesion compressing the optic chiasm (Figure 1A-B). PET-CT demonstrated intense FDG uptake in the pituitary region, as well as involvement in the right lung’s lower, middle, and upper lobes, the left adrenal gland, and multiple lesions in the skeletal system. The patient was evaluated by a multidisciplinary pituitary board, and no clinical signs of acromegaly or Cushing’s syndrome were identified. Due to the high surgical risk given her condition, chemotherapy was promptly planned. Cisplatin and etoposide chemotherapy protocol was started, and the patient's visual impairment subsided following treatment. At the 3-month follow-up her visual complaints and ptosis completely resolved, basal cortisol decreased to 20 μg/dL, ACTH to 60 ng/L, and IGF-1 normalized. Control pituitary MRI releaved significant regression of the lesion (Figure 1C-D). In the first year of chemotherapy, during the pulmonology and oncology follow-up, she was hospitalized because of confusion following radiotherapy for brain metastases. It was later reported that the patient had passed away.ConclusionThe approach to pituitary metastases is generally palliative. On the other hand, if the primary tumor is expected to respond well to chemotherapy and surgery is considered high-risk, close monitoring may be considered to allow chemotherapy to be effective.Figure 1:A-B: Sagittal and coronal pituitary MRI images of the patient before chemotherapy. C-D: Sagittal and coronal pituitary MRI images of the patient 3 months after chemotherapy. Table 1:The patienteGFR: Estimated glomerular filtration rate, ACTH: Adrenocorticotropic hormone, IGF-1: Insulin-like growth factor 1, TSH: Thyroid stimulating hormone, fT4: Free thyroxine, FSH: Follicle-stimulating hormone, LH: Luteinizing hormone, E2: Estradiol, DST: Dexamethasone suppression test

IntroductionMetastases to the pituitary gland are rare complications, usually presenting with diabetes insipidus, headache, visual impairment, and, less commonly, secondary adrenal insufficiency. We present a case of pituitary metastasis of unknown origin with a rapidly progressive course.Clinical CaseA 66-year-old male presented to the emergency department in December 2024 with severe headache unresponsive to analgesics and progressive somnolence. Blood pressure was 160/100 mmHg. Cranial CT revealed a pituitary macroadenoma, and labs showed severe hyponatremia (Na⁺ 111 mmol/L). He was started on IV hydrocortisone (100 mg) and hypertonic saline, and underwent urgent surgery.Postoperatively, he was referred to endocrinology with complaints of nausea, vomiting, drowsiness, and abdominal pain. He denied hypoglycemia, hypotension, polyuria, or visual disturbances. He lost 5 kg over the past month. Physical examination revealed GCS of 14 with mild somnolence; abdominal tenderness was present without defence or rebound.Preoperative labs showed panhypopituitarismHe received hydrocortisone 50 mg q6h and levothyroxine 50 mcg daily. After steroid replacement, hyponatremia improved, but he developed diabetes insipidus characterized by polyuria (200 cc/kg/hour) and low urine specific gravity (1.004).Despite therapy, abdominal pain persisted, and follow-up tests showed rising transaminases and tumor markers (Table-2). Abdominal CT revealed bilateral adrenal masses (5.5 cm, 3.5 cm). PET-CT demonstrated multiple hypermetabolic lymph nodes, adrenal masses suspicious for malignancy, a lung mass with pleural effusion, diffuse thyroid uptake, and peritoneal carcinomatosis.Histopathology of the pituitary lesion was consistent with neuroendocrine carcinoma. SATB2 staining was positive in scattered tumor cells, suggesting a possible lower GI origin (Table-3). Primary site evaluation was planned; however, the patient deteriorated rapidly, required ICU transfer, and died from progressive multiorgan failure in January 2025.ConclusionAlthough pituitary metastases are rare, metastasis should be considered when pituitary insufficiency is detected. Severe hyponatremia, diabetes insipidus at diagnosis, advanced age, and rapid clinical deterioration may represent alarming signs requiring prompt evaluation and intervention.Table 1:Anterior Hypophysis Hormon Results Table 2:Other Laboratory Results Table 3:Pathology Markers for HypopyhsisNo findings supporting a pituitary origin were identified. Scattered SATB2 positivity suggests a possible metastatic tumor, most likely from the lower gastrointestinal tract. Correlation with clinical and radiological findings is recommended.

Foster–Kennedy syndrome (FKS) is often associated with intracranial pathologies in the anterior cranial fossa. Herein, we describe an unusual case of pituitary metastasis presenting as FKS and severe visual loss with a relevant literature review. A 54-year-old woman presented with severe bilateral vision loss. She had been previously treated for metastatic thyroid cancer. At presentation, her fundus findings revealed a variant of FKS and right-eye sixth cranial nerve paresis. On the basis of the temporal visual field defect in the confrontation visual fields, we insisted on repeat neuroimaging. Magnetic resonance imaging revealed compressive lesions in the sellar and occipital areas. Histopathology confirmed thyroid cancer metastasis to the pituitary gland, which was managed with radiotherapy. Partial but useful vision could only be restored in the right eye. Chiasmal compression due to pituitary metastasis is an uncommon cause of visual loss in a known case of cancer.

Background/aim: Positron emission tomography (PET)/CT using 18F-fluorodeoxyglucose (FDG) is a commonly used technique for staging and/or localization in various malignant diseases. Our study aimed to investigate the clinical laboratory and histopathological features of patients with incidental pituitary involvement. Materials and methods: In this retrospective study, approximately 60,000 18-FDG PET/CT scans performed for various indications between May 2012 and December 2020 were reviewed to identify patients with pituitary involvement. The clinical and laboratory characteristics of these patients were investigated using the Hospital Information Management System. Results: Twenty-five patients with incidental pituitary uptake were identified on 18F-FDG PET/CT scans. Eleven patients had macroadenomas. The mean SUVmax levels of the pituitary lesions and different malignancies were statistically similar (13.6 (5.40–38.80) and 11.7 (0.00–116.0), respectively. Six of the 25 patients had nonfunctional adenomas, one patient had a prolactinoma, and four patients had pituitary insufficiency based on hormonal evaluation. Two patients were found to have a pituitary adenoma on histopathological evaluation. One patient had a metastasis from lung carcinoma, as detected radiologically. Conclusion: Incidental pituitary uptake is often overlooked, particularly in the patients with advanced metastatic disease. In individuals with a primary malignancy who are subjected to significant physiological stress from chemotherapy, surgery, and other interventions, timely diagnosing and management of pituitary insufficiency is crucial, as it can significantly impact morbidity and mortality. To develop diagnostic algorithms, predictive models, or systematic follow-up strategies, prospective studies are needed that include hormonal, radiological, and histopathological follow-up data on both the primary malignancy and pituitary metastases.

Pituitary metastasis from renal cell carcinoma (RCC) is exceedingly rare and may mimic pituitary macroadenoma. We report a 62-year-old man with a history of RCC and immune checkpoint inhibitor-induced hypothyroidism who presented with persistent headaches and hypopituitarism. PSMA PET/CT revealed intense uptake in a sellar lesion, raising suspicion of metastasis. Histology following transsphenoidal surgery confirmed RCC metastasis. This case underscores the utility of PSMA PET/CT in RCC staging and restaging, especially helpful in detecting atypical metastases, and highlights the challenge of differentiating metastasis from macroadenoma and immunotherapy-related complications.

Disclosure: N.R. Brott: None. L. Kandimalla: None. M. Hollie: None.Background: Pituitary metastases are rare (∼0.4% of intracranial metastases) and often asymptomatic. Over 60% originate from lung or breast cancer, while ∼2.6% arise from renal cell carcinoma (RCC). We present a rare case of panhypopituitarism due to pituitary metastasis from RCC. Case Report: A 65-year-old male with primary hypothyroidism and recent recurrence of RCC with stage 4 metastasis presented with shock and acute encephalopathy requiring intubation. He had reported headaches, fatigue, and lightheadedness. Seven months prior, an MRI showed a 2.4 cm pituitary mass, presumed to be a macroadenoma. MRI at admission showed interval growth to 3.2 cm with suprasellar extension, optic chiasm compression, hydrocephalus, and cavernous sinus invasion. Labs revealed panhypopituitarism: secondary adrenal insufficiency, central diabetes insipidus (CDI), hypogonadism, and low IGF-1, with mildly elevated prolactin. Pertinent labs included undetectable cortisol at 8 AM (Normal (N): 3.7-19.4mcg/dL), which peaked at 1.4 mcg/dL 60 minutes after administrations of ACTH; undetectable LH and Testosterone; low IGF-1 15 ng/ml (N: 64-240); elevated prolactin 15.68 ng/m (N: 2.64-13.13); TSH 3.3 uIU/ml (N: 0.34-5.60); free T4 0.60 ng/dL (N: 0.54-1.24); low total T3 37 ng/dL (N: 71-180); normal potassium, hypernatremia up to 164 mmol/L (N: 136-145) and inappropriately low urine osmolality at 132 mOsm/kg (N: 150-1150). He was stabilized with hydrocortisone and DDAVP, then underwent transsphenoidal resection. Pathology confirmed metastatic PAX-8-positive RCC. He was discharged with endocrinology and oncology follow-up. Discussion: Pituitary metastases usually occur between ages 60–70 and affect both sexes equally. Most are asymptomatic (93%). CDI is the most common symptom (∼45%), followed by ophthalmoplegia, hemianopsia, headache, fatigue, or hyperprolactinemia. Differentiating metastases from macroadenomas can be difficult—FDG-PET shows no clear distinction, and MRI may be nonspecific. Features suggesting metastasis include rapid growth, thickened stalk, cavernous sinus invasion, sclerotic sella, and suprasellar migration. Conclusion: RCC metastasis to the pituitary is rare but should be considered in cancer patients with new neurologic issues or signs of endocrinopathy. Early recognition enables appropriate endocrine and oncologic management.

Disclosure: K.O. Tolentino: None. V.M. De Castro: None.Background: Central hypothyroidism (CH) from a pituitary macroadenoma is rare ranging from 1 in 80,000 to 120,000 individuals, however, there are no prior reports with this condition coexisting with a papillary thyroid carcinoma (PTCa). CLINICAL CASE: A 67 year woman had a 30 year history of a 1x1 cm neck mass that progressively enlarged later developing easy fatiguability. Initial tests showed normal TSH (0.56 uIU/mL. n 0.27-4.20) but low FT4 (0.77 ng/dL, n 0.93-1.71). Thyroid ultrasound showed a 9.5x 11.7 x 13.1cm right lobe with a 1.8 x 3.3cm ill-defined heterogenous solid nodule, and a 1.9 x 2.8cm ill-defined hypo- and hyperechoic nodule at the left. Neck CT showed a 9.3 x 11.4 x 12.9cm heterogenous right thyroid mass with calcifications and compression of adjacent structures. She was advised surgery but only sought consult after 6 months. Repeat testing showed 2 consecutively low FT4 (0.68 and 0.88 ng/dL), and TSH (0.038 and 0.021 uIU/mL, normal 8am cortisol (16.5 mcg/dL), ACTH (12.3 pg/mL), and PRL (12 mcg/L). Levothyroxine (LT4) 50mcg daily was given and a suppressed TSH <0.005 uIU/mL with normal FT4 1.014 ng/dL was observed after 1 month. A 9 x 12 x 9mm pituitary mass with unaffected optic chiasm was seen on MRI. Total thyroidectomy was done and histopathology revealed an 18.5 cm PTCa, follicular variant, infiltrative, at the right lobe with lymphovascular invasion (ATA high risk). LT4 100 mcg daily was initiated and a repeat CT 2 weeks later showed a lytic mass at the manubrium (4.8 x 4.5 x 4.8 cm) and right 1st anterior rib (3.1 x 4.2 x 3.2cm) with multiple subcentimeter solid, non-calcified lungs metastasis. An initial plan was to give recombinant TSH with RAI, although outcomes are mixed, with increased mortality in higher ATA risk (1), Moreover, in CH, there is decreased stimulation of the NIS, leading to poor iodine uptake on RAI scan and false negative results hence other imaging techniques (F-18 FDG PET/CT or 68Ga-PSMA-11) allows better findings (2,3). Due to the large remnant, referral to TCVS for resection was done but she was lost to follow up. Conclusion: CH remains to be a rare condition that can co-exist with a PTCa. De novo chromosomal mutation of oncogenes still remains to be the more likely cause. RAI can be considered in patients with low TSH, but outcomes are varied, with poorer outcomes in higher risk patients. Monitoring poses a challenge where the use of novel diagnostic imaging studies should be considered.REFERENCE: (1) Butt MI, et al. Papillary Thyroid Cancer With Pituitary Gland Metastasis: A Unique Encounter. Cureus. 2023 Apr 27;15(4)(2) Iqbal A, Rehman A. Thyroid Uptake and Scan. StatPearls. Treasure Island (FL): StatPearls Publishing; 2025 Jan(3) Pitalua-Cortes Q, et al. Head-to-Head Comparison of 68Ga-PSMA-11 and 131I in the Follow-Up of Well-Differentiated Metastatic Thyroid Cancer: A New Potential Theragnostic Agent. Front Endocrinol (Lausanne). 2021;12:794759. Published 2021 Dec 22Presentation: Monday, July 14, 2025

Intraoperative frozen section (FS) pathologic evaluation remains an important part of neurosurgical procedure to ensure proper resection. Follicular thyroid carcinoma (FTC) is a common type of thyroid carcinoma, but metastasis to sellar turcica/pituitary fossa is rare and can be misdiagnosed as pituitary adenoma on FS diagnosis. A 72-year-old female with a history of FTC treated 11 years ago presented to critical care with a pituitary gland lesion. Magnetic resonance imaging (MRI) revealed a 2.8 cm pituitary macroadenoma with sellar expansion and upward displacement of the optic chiasm. Visualization of the lesion and the recent significant growth warranted tumor resection and the intraoperative FS diagnosis was pituitary adenoma. Given the history of FTC and pathological results with occasional follicles present on the permanent sections, immunohistochemistry was performed and the tumor cells were positive for paired box gen 8 (PAX-8), thyroid transcription factor 1 (TTF-1), and thyroglobulin. The final diagnosis was pituitary metastasis of FTC. Next-generation sequencing was performed and revealed novel gene pathogenic mutations of rapamycin-insensitive companion of mammalian target of rapamycin (RICTOR) and Fanconi anemia (FANCA) in the tumor cells. The patient completed radiation treatment without complications and was doing well six months after surgery, with no FTC recurrence or metastasis identified. This case is a rare example of FTC with novel mutations clinically and radiologically mimicking pituitary macroadenoma and illustrates the importance of rigorous histological analysis for accurate diagnosis, particularly during the intraoperative consultation, to ensure proper treatment.

A Rare Case of Small Cell Lung Cancer Presenting as Isolated Pituitary Metastasis With Bilateral Abducens Nerve Palsy

Pituitary metastases (PMs) are rare malignancy manifestations, generally deemed to have an extremely poor prognosis. Differential diagnosis from primary pituitary lesions is often difficult, as their features can mimic those of pituitary neuroendocrine tumours (PitNETs). This study aimed to report a single surgeon's experience in managing PMs and to gather the existing evidence on their clinical and neuroradiological presentation to build a model of 'red flags' that help raise the suspicion of PMs in the context of sellar lesions. We retrieved an original 10-year surgical series of patients undergoing endoscopic transsphenoidal (TNS) surgery for suspected PitNETs, and we additionally conducted a systematic review of case reports or series of patients with PMs. The local series consisted of n = 6 PMs. The literature review yielded n = 149 works reporting n = 340 PMs. Overall, the clinical presentation and neuroradiological features of n = 346 PMs were analysed and compared to data retrieved from n = 361 PitNETs from our original cohort. Primary features associated with PMs were: the presence of headaches (OR 1.24, p = 0.001), visual field deficits (OR 1.19, p = 0.02), extraocular nerve palsies (OR 1.23, p = 0.001), diabetes insipidus (OR 2.13, p < 0.001), MRI features of pituitary stalk/infundibular involvement (OR 1.98, p = 0.001), cavernous sinus invasion (OR 1.57, p = 0.004), and T2w flow voids (OR 1.13, p = 0.001). An incidental diagnosis (OR 0.49, p < 0.001) and cystic changes (OR 0.77, p = 0.02) were less common among PMs. Secondary features involved an acute onset of symptoms (OR 1.25, p = 0.001), the presence of oncological history (OR 1.89, p = 0.001), sellar walls erosion (OR 1.55, p = 0.002), and gross appearance of a firm (OR 2.01, p < 0.001) and easily bleeding lesion (OR 1.99, p < 0.001). Sellar enlargement predicted a lower risk of PMs (OR 0.54, p = 0.001). We have compiled a list of primary and secondary red flags, including clinical and neuroradiological features, to serve as a guiding tool for clinicians to raise suspicion of PMs and aid in the differential diagnosis of various lesions centered in the sella.

A rare case of pituitary metastasis from hepatocellular carcinoma

INTRODUCTION/BACKGROUNDPituitary metastases are rare but clinically significant, most commonly originating from breast or lung cancers. Diabetes insipidus (DI) is the most frequent manifestation of posterior pituitary involvement. We describe a case of pituitary metastasis presenting with panhypopituitarism and central diabetes insipidus (CDI), initially unmasked by adrenal insufficiency. CASEA 68-year-old female with metastatic left breast carcinoma, post-mastectomy and on hormonal therapy, presented with a generalized tonic-clonic seizure and a Glasgow Coma Scale (GCS) score of 4. She exhibited persistent hypoglycemia requiring repeated dextrose corrections, along with hypotensive episodes. Brain CT revealed a well-defined iso-to-hyperdense lesion in the sellar and suprasellar regions (2.0 × 2.5 × 3.0 cm). Subsequent pituitary MRI showed a heterogeneously enhancing lobulated mass (2.2 × 2.5 × 3.0 cm) with loss of normal anterior pituitary architecture. Laboratory tests confirmed adrenal and thyroid insufficiency, with a random cortisol level of 284 nmol/L, TSH at 0.072 µIU/mL, and free T4 below 3.20 mmol/L. Hydrocortisone therapy was initiated, leading to a significant increase in serum sodium from 132 to 160 mmol/L. Serum and urine osmolality measured 318 and 183 mOsm/kg, respectively, with urine sodium under 10 mmol/L, raising suspicion for CDI. Desmopressin was commenced, resulting in improved sodium (145 mmol/L) and osmolality levels (serum 335 mOsm/kg, urine 646 mOsm/kg). Gonadotropin levels (FSH, LH) and estradiol were also low, indicating panhypopituitarism. A multidisciplinary team confirmed pituitary metastasis secondary to breast carcinoma. The patient was transitioned to palliative care with hormone replacement: hydrocortisone, desmopressin, and levothyroxine. CONCLUSIONHypocortisolism in breast cancer patients should raise suspicion for pituitary metastasis. Polyuria after steroid therapy may indicate underlying central diabetes insipidus. Prompt diagnosis and hormone replacement can significantly enhance symptom management and patient well-being.

INTRODUCTION/BACKGROUNDRenal cell carcinoma (RCC) is the most common primary kidney tumor, accounting for 1–3% of adult malignancies. Metastasis of RCC to the pituitary gland is extremely rare, with only a few reported cases. The time interval from primary tumor diagnosis to pituitary metastasis ranges from 3 months to 27 years, with a median interval of 1 year. Surgical resection is the treatment of choice in cases where vision deteriorates due to optic nerve compression. Adjuvant therapies may also be used, including radiotherapy, chemotherapy, immunotherapy, or targeted therapy. Here, we report a case of RCC metastasis to the pituitary presenting with impaired vision. CASEA 62-year-old healthy male presented with progressive blurring of vision in both eyes, where the left eye was completely blind, and the right eye had tunnel vision. Constitutional symptoms occurred four months after undergoing right nephrectomy for RCC stage III. Magnetic resonance imaging revealed an enlarged sella with a solid lesion extending into the suprasellar region, compressing the bilateral optic chiasm and abutting both anterior cerebral arteries. He underwent transsphenoidal surgery, but the procedure was incomplete due to significant bleeding from the vascularized tumor. Two months later, a second decompression surgery was performed to preserve both the optic nerve and chiasm. Postoperatively, he developed panhypopituitarism and required hormone replacement therapy with thyroxine and hydrocortisone. Histopathology examination confirmed metastasis of clear cell renal carcinoma. Hence, radiotherapy and the tyrosine kinase inhibitor (TKI) Pazopanib were used as adjuvant therapies. Following treatment, the patient’s vision remained stable, with neither improvement nor further deterioration. CONCLUSIONThis case underscores the rarity of pituitary metastases from renal cell carcinoma and emphasizes the need for clinicians to consider this complication among patients with unexplained neurological symptoms. A multidisciplinary treatment approach with radiotherapy and TKI has potential benefits in challenging cases with incomplete surgical resection.

Pituitary metastases (PM) account for 0.4% of all intracranial metastases and typically present with visual and endocrinological deficits. Stereotactic radiosurgery (SRS) has shown excellent tumor control and safety profile in the management of intracranial metastases. However, its role and safety in managing metastases to the pituitary gland are not well-characterized. This study aims to evaluate SRS outcomes and safety profile in the management of PM in a multicenter international cohort. The authors retrospectively analyzed data from 63 patients with PM treated with SRS across 12 institutions, assessing clinical and radiological outcomes, including survival rates, tumor control, visual and endocrinological outcomes, and post-treatment complications. Among 63 patients included in the study (median tumor volume: 1.5cc), SRS demonstrated a local tumor control rate of 93.1% at 12 months. The median survival was 25.4 months and overall survival rates of 77.6%, 65.9%, and 55.1% at 6, 12, and 18 months, respectively. In multivariate analysis, a margin dose for PM > 10Gy emerged as an independent predictor across progression-free survival (HR: 0.20, p < 0.01), distant metastasis-free survival (HR: 0.30, p = 0.01), and overall survival. (HR: 0.15, p < 0.01). Following SRS, most patients showed stable or improved visual function (n = 17/18). A small percentage of patients experienced complications: developed new visual deficits (n = 1/63), experienced new anterior pituitary hormone deficiency (n = 5/63), and developed arginine vasopressin (AVP)-deficiency post-treatment (n = 2/63). SRS is an important modality in the management of PM, offering excellent local tumor control and survival outcomes with minimal morbidity. These findings support the incorporation of SRS into the multidisciplinary management for treating patients with PM.

BackgroundThe pituitary gland is an infrequent site for metastasis, encompassing approximately 0.4% of all intracranial metastatic lesions. The prognosis of pituitary metastasis (PM) remains dismal despite considerable advances in therapeutic interventions. Stereotactic radiosurgery (SRS) has been increasingly utilized as a minimally invasive therapeutic option for PMs. This study evaluated the efficacy and safety of SRS in patients with PMs. MethodsOn November 26, 2024, a systematic search was conducted through PubMed, Embase, Scopus, and Web of Science. Studies that have evaluated the role of SRS in PMs or PMs with cavernous sinus invasion were included. The meta-analysis, sensitivity analysis, publication bias evaluation, and meta-regression were conducted using the R program.ResultsSeven studies with 79 individuals with PMs were included. The results showed a pooled local control (LC) rate of 92% (95%CI:83–98%) following intervention. The analysis resulted in a pooled diabetes insipidus (DI) improvement rate of 42% (95%CI:0–100%) and cranial nerve (CN) dysfunction improvement rate of 77% (95%CI:49–98%). In contrast, none of the patients with anterior pituitary dysfunction experienced improvement. The meta-analysis revealed a pooled ARE rate of 2% (95%CI:0–7%) with low heterogeneity (I2 = 0%, P = 0.93). The subgroup analysis for single-session SRS revealed a pooled LC rate of 90% (95%CI:80–98%) and a pooled ARE rate of 2% (95%CI:0–8%). ConclusionSRS is correlated with promising improvement in LC, OS, and CN dysfunction in patients with PM. On the other hand, SRS is accompanied by limited effectiveness in DI and improvement in anterior pituitary dysfunction due to irreversible damage to the pituitary cells by metastatic lesions.