Frago Marquínez Itziar, Fuentes Gómez Clara, Maldonado Castro Gonzalo, Puelles Emaldibarra Nagore, San Miguel López de Uralde Sonia, Echeveste Aizpurua Jon, Arroita González Gorka
Servicio de Medicina Interna, Hospital Txagorritxu, Vitoria-Gasteiz, Alava, Spain.
Endocrinol Nutr. 2009 May;56(5):265-9. doi: 10.1016/S1575-0922(09)71410-X. Epub 2009 Jul 1.
The pituitary is an uncommon site for metastases. We report three cases of patients with a history of cancer (breast and lung) who presented with symptoms of headache, ophthalmoplegia, fatigue, diabetes insipidus, nausea, and vomiting. Cranial magnetic resonance imaging was performed, revealing sellar masses with infiltration of the adjacent tissues compatible with pituitary metastases in all three patients. In two of the patients, hormonal analyses were performed, which showed anterior pituitary insufficiency (thyroid-stimulating hormone and adrenocorticotropic hormone deficiency), symptoms which improved with hormone replacement therapy. Other treatments applied were surgery, radiotherapy and chemotherapy, which show no association with increased survival rates but are able to improve symptoms. The prognosis in all patients was poor. The patients developed further metastases and two died soon after diagnosis. Pituitary function study should be performed in patients with a previous neoplasm and symptoms compatible with hormonal dysfunction or local compressive symptoms.
垂体是转移瘤的少见部位。我们报告3例有癌症(乳腺癌和肺癌)病史的患者,他们出现了头痛、眼肌麻痹、疲劳、尿崩症、恶心和呕吐等症状。进行了头颅磁共振成像检查,结果显示所有3例患者均有鞍区肿块,伴有邻近组织浸润,符合垂体转移瘤表现。其中2例患者进行了激素分析,结果显示垂体前叶功能减退(促甲状腺激素和促肾上腺皮质激素缺乏),这些症状经激素替代治疗后有所改善。所采用的其他治疗方法包括手术、放疗和化疗,这些治疗方法与生存率提高无关,但能够改善症状。所有患者的预后均较差。患者出现了进一步的转移,2例在诊断后不久死亡。对于既往有肿瘤且出现与激素功能障碍或局部压迫症状相符症状的患者,应进行垂体功能检查。