Symptomatic pituitary metastases from renal cell carcinoma |
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Authors: | Thottathil Gopan Steven A Toms Richard A Prayson John H Suh Amir H Hamrahian Robert J Weil |
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Institution: | (1) Department of Endocrinology and Metabolism, Desk A53/Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA;(2) The Brain Tumor and Neuro-oncology Center, ND4-40 LRI/Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA;(3) Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA;(4) Department of Pathology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA;(5) Department of Radiation Oncology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA |
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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. |
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Keywords: | Hypopituitarism Sellar mass Renal cell carcinoma Pituitary metastasis Radiotherapy Transsphenoidal surgery Vascular flow voids Diabetes insipidus |
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