Diagnosis of pituitary metastasis could
Diagnosis of pituitary metastasis could be missed by medical practitioners because most patients who developed pituitary metastasis are clinically asymptomatic. Patients may have signs and symptoms of nausea, vomiting, fatigue, and weight loss, which could also be viewed as pan-hypopituitarism, and also be easily attributed to the side effects of chemotherapy received or the primary malignancy. It can be difficult to diagnose pituitary metastases because the symptoms are nonspecific and the radiological differences from primary tumors are trivial. As imaging techniques have evolved, CT had provided the capability to identify pituitary masses; however, these images are still incapable of enabling reliable differentiation between benign and malignant masses. MRI has perhaps provided a greater possibility of differentiating benign from malignant disease. But there is no definite criterion for distinguishing primary tumor from metastases. Clinicians should bear in mind the additional historical information that could lead to a reasonable suspicion of pituitary metastasis, such as rapid onset and progression of symptom, unsuccessful treatment with bromocriptine, increased age and history of malignancy.
In cases of pituitary metastasis from breast cancer, most patients are elderly and have clinical and/or radiologic evidence of widespread disease. Such metastasis is primarily to the EPZ004777 nodes, lung and bone, at the time they are diagnosed with pituitary metastasis. However, the present case showed solitary pituitary metastasis from breast cancer, and there was no evidence of wide spread disease except existing pituitary metastasis.
Treatment is basically palliative, and depends on the symptoms and the extent of the systemic disease. It ranges from surgical removal, radiation surgery, or systemic chemotherapy, focusing on the extent of the primary tumor. Surgery and even added local radiation are associated with improved symptom relief but do not affect survival rate. In our presenting case, transsphenoidal removal of tumor and radiotherapy improved the patient\'s symptoms. However, further systemic therapy including chemotherapy, endocrine therapy and targeted therapy may extend the life expectancy.
Overall, patient prognosis is poor and depends on the character of primary neoplasm. Prior studies indicate that the mean survival length is 6–7 months. In one investigation, Morita et al found that age over 65 years at presentation, and short duration between initial diagnosis of cancer and pituitary invasion have been related to a poorer outcome. However, patients with a single pituitary metastasis may have a better outcome. As for our presenting case, the patient\'s staging evaluation with PET scan showed a solitary pituitary metastasis, and she had recurrence-free survival exceeding two years during follow-up.
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