Benaiges David, Zanui Montserrat, Chillaron Juan José, Arriola Edurne, Garrigos Laia, Pedro-Botet Juan
Servicio de Endocrinología y Nutrición, Hospital del Mar de Barcelona, España.
Invest Clin. 2012 Dec;53(4):402-7.
Metastases in the sellar region are rare and are frequently found incidentally or in necropsies. Only 7% are reported to be symptomatic. Diabetes insipidus, anterior pituitary dysfunction, visual field defects, headache/pain and ophthalmoplegia are the most commonly reported symptoms. We present the cases of two male patients with a small-cell lung carcinoma whose first clinical symptoms were due to pituitary metastasis. One case presented with symptoms of cavernous sinus invasion and panhypopituitarism and the other case with diabetes insipidus. Both patients had a rapid progression of their disease despite chemotherapy and died after a few months. Pituitary metastases occur most commonly with breast cancer in women and lung cancer in men. The presence of polyuria and polydipsia in an oncologic patient should alert the physician for diabetes insipidus and, if confirmed, an imaging procedure of the pituitary gland is mandatory. Treatment for these tumors is often multimodal and includes surgery, radiation therapy, chemotherapy and hormone replacement. Although surgical series have not shown any significant survival benefits given by tumor resection, the patient's quality of life may be improved.
鞍区转移瘤较为罕见，常在偶然情况下或尸检时发现。据报道，仅有7%的鞍区转移瘤有症状。尿崩症、垂体前叶功能障碍、视野缺损、头痛/疼痛及眼肌麻痹是最常报道的症状。我们报告了两名男性小细胞肺癌患者的病例，他们最初的临床症状均由垂体转移引起。一例表现为海绵窦侵犯和全垂体功能减退症状，另一例表现为尿崩症。尽管接受了化疗，两名患者的病情均迅速进展，数月后死亡。垂体转移瘤在女性中最常与乳腺癌相关，在男性中最常与肺癌相关。肿瘤患者出现多尿和烦渴应提醒医生注意尿崩症，一旦确诊，必须对垂体进行影像学检查。这些肿瘤的治疗通常是多模式的，包括手术、放疗、化疗和激素替代。尽管手术系列研究未显示肿瘤切除能带来任何显著的生存获益，但患者的生活质量可能会得到改善。
