Avula Sreekant, Chauhan Aditya, Clark H Brent, Alameddine Hind
Diabetes, Endocrinology, and Metabolism, University of Minnesota, Minneapolis, USA.
Diabetes, Endocrinology, and Metabolism, University of Minnesota School of Medicine, Minneapolis, USA.
Cureus. 2024 Jul 9;16(7):e64172. doi: 10.7759/cureus.64172. eCollection 2024 Jul.
Metastasis to the pituitary gland is a very rare occurrence. The most common primary cancer that metastasizes to the pituitary are breast cancer and lung cancer. Most of the pituitary metastases are asymptomatic. The most commonly reported symptoms include anterior pituitary dysfunction, visual field defects, headaches, and diabetes insipidus. Metastasis from renal cell carcinoma (RCC) is very rare. Here, we present the case of a 59-year-old male who presented with vision changes, fatigue, low libido, a low appetite, and excessive thirst. The hormonal evaluation was consistent with panhypopituitarism, and he was started on hydrocortisone, levothyroxine, testosterone, and desmopressin. Brain MRI showed a suprasellar enhancing mass that progressively increased in size. He underwent endoscopic endonasal transplanum and transtuberculum approach for tumor removal. Biopsy of the tumor was reported as metastatic RCC. He was later scheduled for a gamma knife. Metastatic RCC to pituitary is rare, with most being asymptomatic, leading to a delay in diagnosis. Treatment of pituitary metastases is not standardized and should be tailored to patients' clinical conditions, histology, and the presence of extrapituitary metastases. More prospective studies are needed to formulate guidelines for the management of pituitary metastases.
垂体转移瘤非常罕见。转移至垂体的最常见原发癌是乳腺癌和肺癌。大多数垂体转移瘤无症状。最常报告的症状包括垂体前叶功能障碍、视野缺损、头痛和尿崩症。肾细胞癌（RCC）转移至垂体极为罕见。在此，我们报告一例59岁男性病例，该患者出现视力改变、疲劳、性欲减退、食欲低下和烦渴。激素评估结果符合全垂体功能减退，遂开始给予氢化可的松、左甲状腺素、睾酮和去氨加压素治疗。脑部磁共振成像（MRI）显示鞍上有一强化肿块，且大小逐渐增大。他接受了经鼻内镜经筛板和经结节入路的肿瘤切除术。肿瘤活检报告为转移性肾细胞癌。他后来被安排接受伽玛刀治疗。肾细胞癌转移至垂体罕见，大多数无症状，导致诊断延迟。垂体转移瘤的治疗尚无标准化方案，应根据患者的临床状况、组织学以及垂体外转移情况进行个体化治疗。需要更多前瞻性研究来制定垂体转移瘤的管理指南。
