[Pituitary metastases in patients with prior neoplasms]. / Metástasis hipofisarias en pacientes con antecedentes neoplásicos.

The pituitary is an uncommon site for metastases. We report three cases of patients with a history of cancer (breast and lung) who presented with symptoms of headache, ophthalmoplegia, fatigue, diabetes insipidus, nausea, and vomiting. Cranial magnetic resonance imaging was performed, revealing sellar masses with infiltration of the adjacent tissues compatible with pituitary metastases in all three patients. In two of the patients, hormonal analyses were performed, which showed anterior pituitary insufficiency (thyroid-stimulating hormone and adrenocorticotropic hormone deficiency), symptoms which improved with hormone replacement therapy. Other treatments applied were surgery, radiotherapy and chemotherapy, which show no association with increased survival rates but are able to improve symptoms. The prognosis in all patients was poor. The patients developed further metastases and two died soon after diagnosis. Pituitary function study should be performed in patients with a previous neoplasm and symptoms compatible with hormonal dysfunction or local compressive symptoms.

Metástasis hipofisarias en pacientes con antecedentes neoplásicos / Pituitary metastases in patients with prior neoplasms

La hipófisis es un lugar infrecuente para las metástasis. Presentamos 3 casos de pacientes con antecedentes de neoplasias (mama y pulmón) que comenzaron con síntomas de cefalea, diplopía, astenia, diabetes insípida, náuseas y vómitos, motivos por los cuales se realizó resonancia craneal; en todos ellos se evidenció una masa en la silla turca con infiltración de tejidos adyacentes, compatible con metástasis pituitaria. En 2 de los casos se realizaron análisis hormonales con hallazgo de insuficiencia pituitaria anterior (déficit de tirotropina y corticotropina), síntomas que mejoraron con tratamiento hormonal sustitutivo. Otros tratamientos aplicados fueron intervención quirúrgica, radioterapia o quimioterapia, los que no conllevan aumento de la supervivencia, pero mejoran los síntomas. El pronóstico en todos los casos fue pobre, 2 pacientes desarrollaron más metástasis y fallecieron al poco tiempo del diagnóstico. Se debería plantear estudio hormonal en pacientes con neoplasias conocidas que reúnan síntomas compatibles con disfunciones hormonales o síntomas compresivos locales (AU)

The pituitary is an uncommon site for metastases. We report three cases of patients with a history of cancer (breast and lung) who presented with symptoms of headache, ophthalmoplegia, fatigue, diabetes insipidus, nausea, and vomiting. Cranial magnetic resonance imaging was performed, revealing sellar masses with infiltration of the adjacent tissues compatible with pituitary metastases in all three patients. In two of the patients, hormonal analyses were performed, which showed anterior pituitary insufficiency (thyroid-stimulating hormone and adrenocorticotropic hormone deficiency), symptoms which improved with hormone replacement therapy. Other treatments applied were surgery, radiotherapy and chemotherapy, which show no association with increased survival rates but are able to improve symptoms. The prognosis in all patients was poor. The patients developed further metastases and two died soon after diagnosis. Pituitary function study should be performed in patients with a previous neoplasm and symptoms compatible with hormonal dysfunction or local compressive symptoms (AU)