Metastases to the Pituitary Gland

Daniel R. Fassett, M.D.; William T. Couldwell, M.D., PhD

Disclosures

May 18, 2004

Outcome of Patients

The vast majority of cases of pituitary metastasis occur in association with multiple systemic metastases and are typically associated with end-stage disease. In an autopsy series, Kovacs[15] found metastatic lesions in other organs in all 18 patients with pituitary metastases. Even in patients in whom no other metastatic disease was noted on the initial metastatic workup report, the prognosis remains grim, because a majority of these patients will harbor microscopic metastatic lesions not detected on evaluation. Morita, et al.,[22] reported that 13 of 17 patients without additional sites of metastases at the time of initial diagnosis died of other metastases within 18 months. Mean survival rates have been reported to be between 6 and 22 months, independent of the treatment strategy.[3,22]

Pituitary metastases are rarely seen by neurosurgeons but should be considered in the differential diagnosis for older patients, patients with a history of malignancy, and patients with symptoms such as DI or ophthalmoplegia. Although the prognosis is poor because of uncontrolled systemic disease, there may be a role for resection in a select group of patients to alleviate symptoms and improve quality of life.

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