Symptomatic pituitary metastases from renal cell carcinoma

Thottathil Gopan, Steven A. Toms, Richard A. Prayson, John H. Suh, Amir H. Hamrahian, Robert J. Weil

Research output: Contribution to journalArticlepeer-review

Abstract

Symptomatic metastases to the pituitary (MP) from renal cell carcinoma (RCC) are rare. In this largest case series reported, we describe the clinical features, treatment and outcome of 5 patients. Over a 6-year period (2000-2006), we treated 5 patients (3 males; mean age 61 years) with large sellar masses and RCC. Four patients had a history of RCC, while in one, RCC was diagnosed after surgery. RCC was diagnosed a median of 11 years prior to diagnosis of MP (range 0-27 years). Four patients had previously developed distant metastases. Clinical presentation included bitemporal hemianopia (3 patients), lethargy (3), headaches (2) and diabetes insipidus (DI) (2). Panhypopituitarism was present in 3 patients and the other two had deficiency of at least ACTH and gonadotropin axes. Elevated prolactin was seen in 3 patients. MRI showed an enhancing sellar mass with suprasellar extension and chiasmal compression in all; prominent vascular flow voids were seen in 2. Three patients underwent transsphenoidal surgery and radiation, while 2 underwent radiotherapy alone. Four patients are alive (follow up 6-46 months); 1 patient died due to systemic metastases at 12 months. Metastases to the pituitary from RCC cause more severe hypopituitarism and visual dysfunction compared to those from other primaries, whereas DI is less common. MRI shows contrast enhancement, stalk involvement, sclerosis and/or erosion of sella and presence of vascular flow voids. Combined treatment using decompressive surgery and stereotactic radiotherapy may result in better outcomes.

Original languageEnglish (US)
Pages (from-to)251-259
Number of pages9
JournalPituitary
Volume10
Issue number3
DOIs
StatePublished - Sep 2007
Externally publishedYes

Keywords

  • Diabetes insipidus
  • Hypopituitarism
  • Pituitary metastasis
  • Radiotherapy
  • Renal cell carcinoma
  • Sellar mass
  • Transsphenoidal surgery
  • Vascular flow voids

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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