Metastatic Tumors to the Pituitary

• Published in: American journal of ophthalmology 1995-06, Vol.119 (6), p.779-785
• Main Authors: AABERG, THOMAS M., KAY, MATTHEW, STERNAU, LINDA
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - secondary; Adenocarcinoma - therapy; Adenoma - diagnosis; Aged; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Breast Neoplasms - diagnosis; Breast Neoplasms - pathology; Breast Neoplasms - therapy; Carcinoma, Small Cell - diagnosis; Carcinoma, Small Cell - secondary; Carcinoma, Small Cell - therapy; Combined Modality Therapy; Diagnosis, Differential; Endocrinopathies; Female; Humans; Hypothalamus. Hypophysis. Epiphysis (diseases); Lung Neoplasms - diagnosis; Lung Neoplasms - pathology; Lung Neoplasms - therapy; Magnetic Resonance Imaging; Male; Malignant tumors; Medical sciences; Middle Aged; Pituitary Neoplasms - diagnosis; Pituitary Neoplasms - secondary; Pituitary Neoplasms - therapy; Radiotherapy; Visual Fields
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/S0002-9394(14)72785-0

To illustrate how the ophthalmologist can distinguish a metastatic tumor to the pituitary from a pituitary adenoma through clinical, particularly ophthalmic, findings. We studied three patients with metastatic disease to the pituitary. One patient had a history of breast cancer without known metastatic disease, and two patients had no previous diagnosis of malignancy. We reviewed the literature with respect to signs and symptoms that may differentiate such lesions from histologically benign pituitary adenomas. Including our patients and the recent cases in the literature, 42% of patients with metastatic tumors had oculomotor palsies, compared with less than 5% of patients with pituitary adenomas. Of patients with metastatic tumors, 33% had diabetes insipidus, compared with 1% who had pituitary adenomas. Furthermore, with respect to differentiating a pituitary adenoma from a metastatic process, radiographic examinations were not helpful, and histopathologic examination was occasionally incorrect. The ophthalmologist can potentially differentiate a metastatic tumor to the pituitary from a pituitary adenoma, thereby assisting in the proper treatment of patients.