title: Clinical and biochemical characteristic features of metastatic cancer to the sella turcica: an analytical review.
abstract: OBJECTIVE
  Sellar metastasis is uncommon and poorly characterized as published data include small series of subjects. This study's goal is to identify unique features that differentiate this entity from other sellar masses such as pituitary macroadenomas.
  
  
  METHODS
  Published cases of pathologically-confirmed sellar metastasis along with our experience in such patients over a 6-years period were reviewed (total = 129). As a control group, we reviewed similar data on 55 patients with pituitary macroadenomas managed over the same time-period. Presenting symptoms, pituitary dysfunction were analyzed using univariate, multivariate and receiver operating characteristic (ROC) analyses.
  
  
  RESULTS
  Sellar metastasis has equal gender distribution with a median patient-age of 56 years. The most common primary malignancy was breast cancer (29%) in women and lung cancer (30%) in men. Sellar metastasis was the first manifestation of cancer in over 40% of patients. Common presenting symptoms included headaches, visual field deficits, abnormal eye motility and diabetes insipidus. These symptoms were less frequent among patients with pituitary macroadenomas. Univariate regression analyses showed that headaches, abnormal eye motility, visual field deficits and diabetes insipidus were each predictive of metastatic disease. ROC analysis combining all 4 features revealed an AUC of 0.953 with a sensitivity of 0.818 and a specificity of 0.935. Using the multivariate regression, abnormal eye motility and/or diabetes insipidus independently predicted metastatic disease.
  
  
  CONCLUSIONS
  Sellar metastasis should be suspected in patients presenting with sellar masses, abnormal eye motility and/or diabetes insipidus even those without known malignancy since pituitary metastasis can often be the first manifestation of cancer.
authors: Division of Clinical and Molecular Endocrinology, University Hospitals/Case Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
authors: Ribal
authors: R
authors: Al-Aridi
authors: Katia
authors: K
authors: El Sibai
authors: Pingfu
authors: P
authors: Fu
authors: Mehreen
authors: M
authors: Khan
authors: Warren R
authors: WR
authors: Selman
authors: Baha M
authors: BM
authors: Arafah
mesh_terms: D003919:Diabetes Insipidus / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010911:Pituitary Neoplasms / Q000150:complications / Q000473:pathology / Q000556:secondary*; D012658:Sella Turcica / Q000473:pathology*