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Pia Burman

Physician

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Pituitary Metastases : A Nationwide Study on Current Characteristics with Special Reference to Breast Cancer

Author

  • Fredrika Schill
  • Margareta Nilsson
  • Daniel S. Olsson
  • Oskar Ragnarsson
  • Katarina Berinder
  • Britt Edén Engström
  • Per Dahlqvist
  • Jeanette Wahlberg
  • Elisabet Englund
  • Pia Burman

Summary, in English

Objective To investigate the contemporary presentation of pituitary metastases. Patients Thirty-eight patients diagnosed with pituitary metastases from 1996 to 2018 in Sweden. Methods Pituitary metastases were confirmed by histopathology (n = 27) or considered highly likely according to radiological findings, including rapid tumor progression (n = 11). Medical records were reviewed and sellar images reexamined centrally. Results Breast and lung cancers were the most common primary tumors, in 45% and 21% of patients, respectively. Sixty-seven percent of breast cancers overexpressed human epidermal growth factor receptor 2 (HER2); 53% of pituitary metastases from breast cancers appeared ≥10 years after diagnosis of the primary tumor. At presentation, 71% appeared to have ACTH deficiency, 65% had TSH deficiency, and 26% had diabetes insipidus. Fatigue, nausea/vomiting, loss of appetite, weight loss, myalgia, and/or arthralgia were reported in 47% of patients with morning cortisol <100 nmol/L vs 23% with cortisol ≥200 nmol/L. Sixteen patients had visual field defects, and eight had diplopia. Intrasellar and suprasellar tumor growth was the most frequent finding. Initially, a pituitary adenoma was considered the etiology in 18% of patients. Radiotherapy, pituitary surgery, and chemotherapy were used in 68%, 68%, and 11% of patients, respectively. One and 2 years after diagnosis of pituitary metastases, 50% and 26% of patients were alive. Conclusion Pituitary metastases may be mistaken for pituitary adenomas and can appear late, especially in breast cancer. Breast cancers overexpressing HER2 seem prone to metastasize to the pituitary. Hypocortisolism may be misdiagnosed as cancer-related malaise. An increased awareness of pituitary metastases and undiagnosed pituitary failure can improve management in these patients.

Department/s

  • Cardiovascular Research - Hypertension
  • Tumor microenvironment
  • Genomics, Diabetes and Endocrinology

Publishing year

2019-08

Language

English

Pages

3379-3388

Publication/Series

Journal of Clinical Endocrinology and Metabolism

Volume

104

Issue

8

Document type

Journal article

Publisher

Oxford University Press

Topic

  • Cancer and Oncology

Status

Published

Research group

  • Cardiovascular Research - Hypertension
  • Genomics, Diabetes and Endocrinology

ISBN/ISSN/Other

  • ISSN: 0021-972X