Pituitary metastases: role of surgery.

OBJECTIVE

To evaluate the clinical and radiographic manifestations of pituitary metastases (PM), discuss the role of surgery, and briefly review the pertinent literature.

METHODS

At a single institution between January 1992 and July 2011, 15 patients with PM were surgically treated (all cases were confirmed by histologic analysis). Of patients, 14 complained of visual impairment, 8 complained of headache, 4 complained of ophthalmoplegia, and 11 complained of endocrine disturbances manifesting as diabetes insipidus (7 patients) and anterior hypopituitarism (4 patients).

RESULTS

After transsphenoidal surgery, visual disturbances improved in 12 cases, headache improved in 5 cases, and ophthalmoplegia improved in 2 cases. Endocrinologic function remained unchanged in all cases. The mean survival time was 11.8 months (range, 3-43 months); one patient still survives after 33 months.

CONCLUSIONS

The study cohort includes patients representing two clinical situations: (i) patients with a preoperative suspicion of PM and (ii) patients in whom the metastasis was an unexpected finding during surgery performed for a presumed pituitary adenoma. The former situation is indicative of the possibilities and limits of surgery, which may confirm the diagnosis but is only palliative, improving quality of life without improving life expectancy. The latter situation reveals how misleading clinical and radiographic features of PM can be. Considering these results, surgical treatment of PM should be specifically decided based on patient performance status, tumor staging, and patient preference.