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Metastatic involvement of the pituitary gland: a systematic review with pooled individual patient data analysis
Purpose To report a rare case of pituitary metastasis (PM) from hepatocellular carcinoma (HCC) and help better understand the incidence of PM and its most common presenting symptoms through a pooled individual patient data analysis. Methods Literature regarding PM was systematically reviewed with a...
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| Published in: | Pituitary 2015-02, Vol.18 (1), p.159-168 |
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| creator | He, Wenzhuan Chen, Fangxiang Dalm, Brian Kirby, Patricia A. Greenlee, Jeremy D. W. |
| description | Purpose
To report a rare case of pituitary metastasis (PM) from hepatocellular carcinoma (HCC) and help better understand the incidence of PM and its most common presenting symptoms through a pooled individual patient data analysis.
Methods
Literature regarding PM was systematically reviewed with a pooled individual patient data analysis conducted. Pooled individual data analysis result is also compared with the result in a most recent systematic review.
Results
Our results demonstrate that the incidence of PM among all intracranial metastases is 0.87 % (95 % CI 0.56, 1.18); it is 1.9 % (95 % CI 1.46, 2.34) among all autopsied cancer cases; it is 11.56 % (95 % CI 7.08, 16.04) among all breast cancer patients who had hypophysectomies and 12.83 % (95 % CI 10.5, 15.16) among all autopsied breast cancer patients. The fixed effect model showed that the incidence of PM in breast cancer patients group is significantly higher (
p
|
| doi_str_mv | 10.1007/s11102-014-0552-2 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1654684084</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1654684084</sourcerecordid><originalsourceid>FETCH-LOGICAL-c475t-d98da179f1e57fbd3e371750a18a5e822d9b04550e7314e7d773e95dd751c1473</originalsourceid><addsrcrecordid>eNqNkU1LHTEUhkOx1I_2B3QjATduRnPyMZnpTsTagtKNQnchd3JGIzOT6SRz5f57M722iCC4SiDP-4RzXkK-AjsBxvRpBADGCwayYErxgn8ge6C0KLRkYiffRVUWQsLvXbIf4wNjOSXkJ7LLpZRKlWqPhGtMNiabfEP9sA7dGnscEg0tTfdIR59mn-y0oXedHdw3amncxIT938CEa4-P9NGnezqG0KHLDufX3s22o2NmFpWzyVI72G4TffxMPra2i_jl-Twgt98vbs5_FFe_Ln-en10VjdQqFa6unAVdt4BKtysnUGjQilmorMKKc1evWB6BoRYgUTutBdbKOa2gAanFATneescp_JkxJtP72GCXp8AwRwOlkmUlWSXfg3JR17xarEev0IcwT3m0hZIl1wBVnSnYUs0UYpywNePk-7xEA8wsxZltcSYXZ5biDM-Zw2fzvOrR_U_8ayoDfAvE_DTc4fTi6zetTy-7o0M</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1646271189</pqid></control><display><type>article</type><title>Metastatic involvement of the pituitary gland: a systematic review with pooled individual patient data analysis</title><source>Springer Nature</source><creator>He, Wenzhuan ; Chen, Fangxiang ; Dalm, Brian ; Kirby, Patricia A. ; Greenlee, Jeremy D. W.</creator><creatorcontrib>He, Wenzhuan ; Chen, Fangxiang ; Dalm, Brian ; Kirby, Patricia A. ; Greenlee, Jeremy D. W.</creatorcontrib><description>Purpose
To report a rare case of pituitary metastasis (PM) from hepatocellular carcinoma (HCC) and help better understand the incidence of PM and its most common presenting symptoms through a pooled individual patient data analysis.
Methods
Literature regarding PM was systematically reviewed with a pooled individual patient data analysis conducted. Pooled individual data analysis result is also compared with the result in a most recent systematic review.
Results
Our results demonstrate that the incidence of PM among all intracranial metastases is 0.87 % (95 % CI 0.56, 1.18); it is 1.9 % (95 % CI 1.46, 2.34) among all autopsied cancer cases; it is 11.56 % (95 % CI 7.08, 16.04) among all breast cancer patients who had hypophysectomies and 12.83 % (95 % CI 10.5, 15.16) among all autopsied breast cancer patients. The fixed effect model showed that the incidence of PM in breast cancer patients group is significantly higher (
p
< 0.001) with an odds ratio of 6.71 (95 % CI 4.24, 10.61). Breast and lung cancer are the most common primary cancer of PM with a percentage of 37.2 and 24.2 respectively. The next most common primary sites are prostate and kidney respectively, although the percentages for each are only about 5. Diabetes insipidus (DI) remains the most common symptom among all reported PM cases with a pooled incidence of 42.34 % (95 % CI 36.15, 48.53). Although not significant (χ
2
= 2.846,
df
= 1,
p
= 0.061), it is less common in the most recent reported cases which has a pooled incidence of 32.76 % (95 % CI 20.31, 45.21). DI is extremely rare in the reported PM cases from HCC (none of the eight cases presented with DI). The symptoms of anterior hypopituitarism (23.68 vs 39.66 %,
p
= 0.015), visual deterioration (27.89 vs 41.38 %,
p
= 0.039), cranial nerve palsies (21.58 vs 41.38 %,
p
= 0.003) and headaches (15.79 vs 32.76 %,
p
= 0.005) were reported significantly higher than previously described in the literature.
Conclusions
Pituitary metastasis is rare in patients with cancer, and the pituitary gland is an uncommonly involved location in patients with intracranial metastases. With advanced diagnostic imaging techniques and increased awareness about the manifestation of sellar lesions, the incidence of cranial nerve palsies and anterior pituitarism are higher than reported. This information may allow earlier diagnosis of PM.</description><identifier>ISSN: 1386-341X</identifier><identifier>EISSN: 1573-7403</identifier><identifier>DOI: 10.1007/s11102-014-0552-2</identifier><identifier>PMID: 24445565</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>Adult ; Aged ; Breast Neoplasms - pathology ; Diabetes Insipidus - pathology ; Endocrinology ; Human Physiology ; Humans ; Hypopituitarism - pathology ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Neoplasm Metastasis - pathology ; Pituitary Gland - pathology ; Pituitary Neoplasms - pathology</subject><ispartof>Pituitary, 2015-02, Vol.18 (1), p.159-168</ispartof><rights>Springer Science+Business Media New York 2014</rights><rights>Springer Science+Business Media New York 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-d98da179f1e57fbd3e371750a18a5e822d9b04550e7314e7d773e95dd751c1473</citedby><cites>FETCH-LOGICAL-c475t-d98da179f1e57fbd3e371750a18a5e822d9b04550e7314e7d773e95dd751c1473</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24445565$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>He, Wenzhuan</creatorcontrib><creatorcontrib>Chen, Fangxiang</creatorcontrib><creatorcontrib>Dalm, Brian</creatorcontrib><creatorcontrib>Kirby, Patricia A.</creatorcontrib><creatorcontrib>Greenlee, Jeremy D. W.</creatorcontrib><title>Metastatic involvement of the pituitary gland: a systematic review with pooled individual patient data analysis</title><title>Pituitary</title><addtitle>Pituitary</addtitle><addtitle>Pituitary</addtitle><description>Purpose
To report a rare case of pituitary metastasis (PM) from hepatocellular carcinoma (HCC) and help better understand the incidence of PM and its most common presenting symptoms through a pooled individual patient data analysis.
Methods
Literature regarding PM was systematically reviewed with a pooled individual patient data analysis conducted. Pooled individual data analysis result is also compared with the result in a most recent systematic review.
Results
Our results demonstrate that the incidence of PM among all intracranial metastases is 0.87 % (95 % CI 0.56, 1.18); it is 1.9 % (95 % CI 1.46, 2.34) among all autopsied cancer cases; it is 11.56 % (95 % CI 7.08, 16.04) among all breast cancer patients who had hypophysectomies and 12.83 % (95 % CI 10.5, 15.16) among all autopsied breast cancer patients. The fixed effect model showed that the incidence of PM in breast cancer patients group is significantly higher (
p
< 0.001) with an odds ratio of 6.71 (95 % CI 4.24, 10.61). Breast and lung cancer are the most common primary cancer of PM with a percentage of 37.2 and 24.2 respectively. The next most common primary sites are prostate and kidney respectively, although the percentages for each are only about 5. Diabetes insipidus (DI) remains the most common symptom among all reported PM cases with a pooled incidence of 42.34 % (95 % CI 36.15, 48.53). Although not significant (χ
2
= 2.846,
df
= 1,
p
= 0.061), it is less common in the most recent reported cases which has a pooled incidence of 32.76 % (95 % CI 20.31, 45.21). DI is extremely rare in the reported PM cases from HCC (none of the eight cases presented with DI). The symptoms of anterior hypopituitarism (23.68 vs 39.66 %,
p
= 0.015), visual deterioration (27.89 vs 41.38 %,
p
= 0.039), cranial nerve palsies (21.58 vs 41.38 %,
p
= 0.003) and headaches (15.79 vs 32.76 %,
p
= 0.005) were reported significantly higher than previously described in the literature.
Conclusions
Pituitary metastasis is rare in patients with cancer, and the pituitary gland is an uncommonly involved location in patients with intracranial metastases. With advanced diagnostic imaging techniques and increased awareness about the manifestation of sellar lesions, the incidence of cranial nerve palsies and anterior pituitarism are higher than reported. This information may allow earlier diagnosis of PM.</description><subject>Adult</subject><subject>Aged</subject><subject>Breast Neoplasms - pathology</subject><subject>Diabetes Insipidus - pathology</subject><subject>Endocrinology</subject><subject>Human Physiology</subject><subject>Humans</subject><subject>Hypopituitarism - pathology</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neoplasm Metastasis - pathology</subject><subject>Pituitary Gland - pathology</subject><subject>Pituitary Neoplasms - pathology</subject><issn>1386-341X</issn><issn>1573-7403</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNqNkU1LHTEUhkOx1I_2B3QjATduRnPyMZnpTsTagtKNQnchd3JGIzOT6SRz5f57M722iCC4SiDP-4RzXkK-AjsBxvRpBADGCwayYErxgn8ge6C0KLRkYiffRVUWQsLvXbIf4wNjOSXkJ7LLpZRKlWqPhGtMNiabfEP9sA7dGnscEg0tTfdIR59mn-y0oXedHdw3amncxIT938CEa4-P9NGnezqG0KHLDufX3s22o2NmFpWzyVI72G4TffxMPra2i_jl-Twgt98vbs5_FFe_Ln-en10VjdQqFa6unAVdt4BKtysnUGjQilmorMKKc1evWB6BoRYgUTutBdbKOa2gAanFATneescp_JkxJtP72GCXp8AwRwOlkmUlWSXfg3JR17xarEev0IcwT3m0hZIl1wBVnSnYUs0UYpywNePk-7xEA8wsxZltcSYXZ5biDM-Zw2fzvOrR_U_8ayoDfAvE_DTc4fTi6zetTy-7o0M</recordid><startdate>20150201</startdate><enddate>20150201</enddate><creator>He, Wenzhuan</creator><creator>Chen, Fangxiang</creator><creator>Dalm, Brian</creator><creator>Kirby, Patricia A.</creator><creator>Greenlee, Jeremy D. W.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20150201</creationdate><title>Metastatic involvement of the pituitary gland: a systematic review with pooled individual patient data analysis</title><author>He, Wenzhuan ; Chen, Fangxiang ; Dalm, Brian ; Kirby, Patricia A. ; Greenlee, Jeremy D. W.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-d98da179f1e57fbd3e371750a18a5e822d9b04550e7314e7d773e95dd751c1473</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Breast Neoplasms - pathology</topic><topic>Diabetes Insipidus - pathology</topic><topic>Endocrinology</topic><topic>Human Physiology</topic><topic>Humans</topic><topic>Hypopituitarism - pathology</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neoplasm Metastasis - pathology</topic><topic>Pituitary Gland - pathology</topic><topic>Pituitary Neoplasms - pathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>He, Wenzhuan</creatorcontrib><creatorcontrib>Chen, Fangxiang</creatorcontrib><creatorcontrib>Dalm, Brian</creatorcontrib><creatorcontrib>Kirby, Patricia A.</creatorcontrib><creatorcontrib>Greenlee, Jeremy D. W.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Pituitary</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>He, Wenzhuan</au><au>Chen, Fangxiang</au><au>Dalm, Brian</au><au>Kirby, Patricia A.</au><au>Greenlee, Jeremy D. W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Metastatic involvement of the pituitary gland: a systematic review with pooled individual patient data analysis</atitle><jtitle>Pituitary</jtitle><stitle>Pituitary</stitle><addtitle>Pituitary</addtitle><date>2015-02-01</date><risdate>2015</risdate><volume>18</volume><issue>1</issue><spage>159</spage><epage>168</epage><pages>159-168</pages><issn>1386-341X</issn><eissn>1573-7403</eissn><abstract>Purpose
To report a rare case of pituitary metastasis (PM) from hepatocellular carcinoma (HCC) and help better understand the incidence of PM and its most common presenting symptoms through a pooled individual patient data analysis.
Methods
Literature regarding PM was systematically reviewed with a pooled individual patient data analysis conducted. Pooled individual data analysis result is also compared with the result in a most recent systematic review.
Results
Our results demonstrate that the incidence of PM among all intracranial metastases is 0.87 % (95 % CI 0.56, 1.18); it is 1.9 % (95 % CI 1.46, 2.34) among all autopsied cancer cases; it is 11.56 % (95 % CI 7.08, 16.04) among all breast cancer patients who had hypophysectomies and 12.83 % (95 % CI 10.5, 15.16) among all autopsied breast cancer patients. The fixed effect model showed that the incidence of PM in breast cancer patients group is significantly higher (
p
< 0.001) with an odds ratio of 6.71 (95 % CI 4.24, 10.61). Breast and lung cancer are the most common primary cancer of PM with a percentage of 37.2 and 24.2 respectively. The next most common primary sites are prostate and kidney respectively, although the percentages for each are only about 5. Diabetes insipidus (DI) remains the most common symptom among all reported PM cases with a pooled incidence of 42.34 % (95 % CI 36.15, 48.53). Although not significant (χ
2
= 2.846,
df
= 1,
p
= 0.061), it is less common in the most recent reported cases which has a pooled incidence of 32.76 % (95 % CI 20.31, 45.21). DI is extremely rare in the reported PM cases from HCC (none of the eight cases presented with DI). The symptoms of anterior hypopituitarism (23.68 vs 39.66 %,
p
= 0.015), visual deterioration (27.89 vs 41.38 %,
p
= 0.039), cranial nerve palsies (21.58 vs 41.38 %,
p
= 0.003) and headaches (15.79 vs 32.76 %,
p
= 0.005) were reported significantly higher than previously described in the literature.
Conclusions
Pituitary metastasis is rare in patients with cancer, and the pituitary gland is an uncommonly involved location in patients with intracranial metastases. With advanced diagnostic imaging techniques and increased awareness about the manifestation of sellar lesions, the incidence of cranial nerve palsies and anterior pituitarism are higher than reported. This information may allow earlier diagnosis of PM.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>24445565</pmid><doi>10.1007/s11102-014-0552-2</doi><tpages>10</tpages></addata></record> |
| fulltext | fulltext |
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| language | eng |
| recordid | cdi_proquest_miscellaneous_1654684084 |
| source | Springer Nature |
| subjects | Adult Aged Breast Neoplasms - pathology Diabetes Insipidus - pathology Endocrinology Human Physiology Humans Hypopituitarism - pathology Male Medicine Medicine & Public Health Middle Aged Neoplasm Metastasis - pathology Pituitary Gland - pathology Pituitary Neoplasms - pathology |
| title | Metastatic involvement of the pituitary gland: a systematic review with pooled individual patient data analysis |
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