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

Artikel i vetenskaplig tidskrift
Författare Fredrika Schill
Margareta Nilsson
Daniel S Olsson
Oskar Ragnarsson
Katarina Berinder
Britt Edén Engström
Per Dahlqvist
Jeanette Wahlberg
Elisabet Englund
Pia Burman
Publicerad i The Journal of clinical endocrinology and metabolism
Volym 104
Nummer/häfte 8
Sidor 3379-88
ISSN 1945-7197
Publiceringsår 2019
Publicerad vid Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition
Sidor 3379-88
Språk en
Länkar dx.doi.org/10.1210/jc.2019-00012
www.ncbi.nlm.nih.gov/entrez/query.f...
Ämneskategorier Endokrinologi

Sammanfattning

To investigate the contemporary presentation of pituitary metastases.Thirty-eight patients diagnosed with pituitary metastases 1996 to 2018 in Sweden.Pituitary metastases were confirmed by histopathology (n = 27) or considered highly likely due to radiological findings, including rapid tumor progression (n = 11). Medical charts were reviewed and sellar images re-examined centrally.Breast and lung cancer were the most common primary tumors, 45% and 21% of the patients. The pituitary was the only metastatic site in 9 patients. 67% of the breast cancers overexpressed HER2. 53% of the 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. 47% of patients with morning cortisol <100 nmol/L vs 23% with cortisol ≥200 nmol/L reported fatigue, nausea/vomiting, loss of appetite, weight loss, myalgia and/or arthralgia. Sixteen patients had visual field defects, eight had diplopia. Intra- and suprasellar tumor growth was the most frequent finding. Initially, a pituitary adenoma was considered to be the etiology in 18% of the patients. Radiotherapy, pituitary surgery, and chemotherapy were used in 68%, 68% and 11% of the patients. One and 2 years after diagnosis of PM, 50% and 26% of the patients were alive.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 PM and undiagnosed pituitary failure can improve the management in these patients.

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