Pituitary Metastasis: The Moffitt Cancer Center Experience

Introduction: Pituitary metastases of systemic cancers are rare diagnosis, thought to comprise 1% of surgical pituitary tumors. The prognosis is poor with median survival up to 16.5 months.

Methods: The authors performed a retrospective chart review of all patients who underwent transsphenoidal pituitary tumor resection at the Moffitt Cancer Center from 2008 to 2018. Patient demographics (age and gender), clinical characteristics (neurologic, cranial nerve or visual deficits, and KPS), tumor characteristics (tumor type and location), and overall survival were assessed.

Results: Seventy-four patients underwent transsphenoidal surgery for pituitary region tumors. Twenty patients (27%) have known systemic cancer. Nine patients (12%) were found to have metastasis to the pituitary gland or infundibulum from their systemic cancer, which represent 45% (9/20) of patients with known systemic cancers. Average age was 59.7 ± 11.1 years. Tumor pathology consisted of breast (33%), lung (33%), esophageal (11%), renal (11%), and pancreatic (11%). Two patients presented with the pituitary lesion as their initial diagnosis of disease. Four patients (33%) also had intraparenchymal metastases at the time of diagnosis of pituitary lesions. Headaches (44%), hormonal abnormality (55%) and visual complaints (33%) were the most common symptom at diagnosis. Treatment consisted of surgical resection and radiation in five patients (55%), biopsy and radiation in three patients (33%), and surgery alone in one patient (11%) who died prior to radiation. Average follow-up in our patient population was 454 days (range: 21–1,762). Overall survival averaged 17 months (range: 0–57) months.

Conclusion: This study identifies a high percentage of pituitary metastasis among patients with known primary systemic disease. The prognosis remains poor with an overall survival of 17 months despite treatment. This lays the groundwork for prospective studies on patients with systemic cancer and suprasellar tumors to determine whether earlier diagnosis and intervention may extend survival.

Publication History

Article published online:
12 February 2021