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Pituitary Metastases: A Nationwide Study on Current Characteristics With Special Reference to Breast Cancer
Lund Univ, Sweden.
Skane Univ Hosp, Sweden.
Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
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2019 (English)In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 104, no 8, p. 3379-3388Article in journal (Refereed) Published
Abstract [en]

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 cellar 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 amp;gt;= 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 amp;lt;100 nmol/L vs 23% with cortisol amp;gt;= 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.

Place, publisher, year, edition, pages
ENDOCRINE SOC , 2019. Vol. 104, no 8, p. 3379-3388
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:liu:diva-160438DOI: 10.1210/jc.2019-00012ISI: 000482558500041PubMedID: 30892659OAI: oai:DiVA.org:liu-160438DiVA, id: diva2:1353450
Note

Funding Agencies|Skane University Hospital, Skane Region, Sweden

Available from: 2019-09-23 Created: 2019-09-23 Last updated: 2019-09-23

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Wahlberg, Jeanette
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Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Endocrinology
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