ABSTRACT
Las metástasis en la silla turca son raras y se encuentran en muchas ocasiones incidentalmente o en necropsias. Solo un 7% de los casos son sintomáticos. Las manifestaciones clínicas más frecuentes son la diabetes insípida, la clínica compresiva y los síntomas derivados de déficit hormonales de la adenohipófisis. Se presentan los casos de 2 varones con un carcinoma microcítico de pulmón cuya manifestación clínica inicial correspondía a afectación metastásica de la silla turca. Un caso debutó con invasión del seno cavernoso y panhipopituitarismo, y el otro con una diabetes insípida. Ambos casos presentaron una rápida progresión de su enfermedad neoplásica, con escasa respuesta al tratamiento sistémico en uno de los casos y fueron éxitus a los pocos meses. Las metástasis hipofisarias se presentan con mayor frecuencia en mujeres con cáncer de mama y hombres con neoplasias de pulmón. La presencia de poliuria y polidipsia en un paciente oncológico debe hacer sospechar una diabetes insípida, siendo necesario un estudio de imagen de la silla turca. El tratamiento de estos tumores incluye la cirugía, la radioterapia, la quimioterapia y el tratamiento hormonal sustitutivo. A pesar que el tratamiento quirúrgico no se ha asociado a un aumento de la supervivencia, algunos pacientes pueden mejorar su calidad de vida.
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 patients quality of life may be improved.
Subject(s)
Aged , Humans , Male , Lung Neoplasms/pathology , Pituitary Neoplasms/secondary , Small Cell Lung Carcinoma/secondaryABSTRACT
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.