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LETTER TO THE EDITOR
Year : 2012  |  Volume : 16  |  Issue : 1  |  Page : 147-148

Pituitary metastasis as a presenting manifestation of silent systemic malignancy: A retrospective analysis of four cases


Department of Endocrine and Metabolic Surgery, Mamata Medical College and Superspeciality Hospital, Khammam, Andhra Pradesh, India

Date of Web Publication26-Dec-2011

Correspondence Address:
P. R. K. Bhargav
Department of Endocrine and Metabolic Surgery, Mamata Medical College and Super speciality Hospital, Khammam - 507 002, Andhra Pradesh
India
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DOI: 10.4103/2230-8210.91215

PMID: 22276271

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How to cite this article:
Bhargav P. Pituitary metastasis as a presenting manifestation of silent systemic malignancy: A retrospective analysis of four cases. Indian J Endocr Metab 2012;16:147-8

How to cite this URL:
Bhargav P. Pituitary metastasis as a presenting manifestation of silent systemic malignancy: A retrospective analysis of four cases. Indian J Endocr Metab [serial online] 2012 [cited 2014 Nov 22];16:147-8. Available from: http://www.ijem.in/text.asp?2012/16/1/147/91215

Sir,

It is an informative and a well-drafted attempt to take an endocrinological view of pituitary metastases from a distant primary.[1] But, I have few queries and observations to extend. First, most of the described points in conclusion such as short lag time, diabetes insipidus (DI), rapidly appearing sellar mass, etc., can occur in adenomas with hemorrhage, cysts, hypophysitis, and pseudotumours which are much common than pituitary metastasis (PM).[2],[3],[4] Second, metastases can occur in preexisting adenomas leading to a sudden increase in the size of tumor.[5] Though PM tends to involve neurohypophysis earlier than adenohypophysis, only one case had preoperative DI and two cases had postoperative DI, which can occur as a complication of any hypophyseal surgery. Third, another differential diagnosis in the first two cases can be the rarely encountered pituitary carcinoma.[6] As seen in the second case, PM is highly unlikely given the gland size and accessibility for a distant primary to metastasize. Fourth, what were the exact histopathological findings and was any immunohistochemistry done to strengthen the diagnosis of PM? Occassionally, the Ki-67 proliferation index and electron microscopic ultrastructural features matched between PM and primary are useful to have definitive diagnosis and prognostication.[7] The histopathological features alone may not be sufficient to differentiate between adenoma, carcinoma, and PM. Fifth, the isolated presentation of a systemic malignancy with PM could be due to referral bias or chronology of clinical documentation, as such cases are anecdotal to the best of our knowledge.

Last, we have to be very critical in labeling a case as PM as clinically, radiologically, and biochemically, the overlap with other pituitary pathologies is significant and the prognostic difference is significant.

 
   References Top

1.Dutta P, Bhansali A, Shah VN, Walia R, Bhadada SK, Paramjeet S, et al. Pituitary metastasis as a presenting manifestation of silent systemic malignancy: A retrospective analysis of four cases. Indian J Endocrinol Metab 2011;15 Suppl 3:S242-5.  Back to cited text no. 1
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2.Katayama S, Yokota C. Diabetes insipidus and lymphocytic hypophysitis. Intern Med 2003;42:924-5.  Back to cited text no. 2
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3.Santos AR, Fonseca Neto RM. Endoscopic endonasaltranssphenoidal approach for pituitary adenomas: Technical aspects and report of casuistic. Arq Neuropsiquiatr 2010;68:608-12.  Back to cited text no. 3
    
4.Francois I, Casteels I, Silberstein J, Casaer P, de Zegher F. Empty sella, growth hormone deficiency and pseudotumourcerebri: Effect of initiation, withdrawal and resumption of growth hormone therapy. Eur J Pediatr 1997;156:69-70.  Back to cited text no. 4
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5.Zager EL, Hedley-Whyte ET. Metastasis within a pituitary adenoma presenting with bilateral abducens palsies: Case report and review of literature. Neurosurgery 1987;21:383-6.  Back to cited text no. 5
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6.Pernicone PJ, Scheithauer BW, Sebo TJ, Kovacs KT, Horvath E, Young WF Jr, et al. Pituitary carcinoma: A clinicopathologic study of 15 cases. Cancer 1997;79:804-12.  Back to cited text no. 6
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7.Ironside JW. Best practice no 172: Pituitary gland pathology. J Clin Pathol 2003;56:561-8.  Back to cited text no. 7
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