title: Pituitary Metastasis from Renal Cell Carcinoma: Description of a Case Report.
abstract: BACKGROUND Pituitary metastasis is uncommon, breast and lung cancers being the most frequent primary tumors. Renal cell carcinoma (RCC) is a rare cause of pituitary metastases, with only a few cases described to date. CASE REPORT We report a case of a 61-year-old man who presented with a progressive deterioration of visual acuity and field associated with a bitemporal hemianopsia. Two years ago, he underwent radical right nephrectomy for a clear cell RCC (ccRCC). The biological tests showed pan-hypopituitarism and diabetes insipidus. Brain MRI revealed a large sellar tumor lesion bilaterally infiltrating the cavernous sinuses, which was surgically resected. Histology confirmed a ccRCC pituitary metastasis. The patient received post-surgical radiotherapy. Considering the presence of concomitant extra-pituitary metastases, treatment with sunitinib was started, followed by several lines of therapy with axitinib, everolimus, and sorafenib because of tumor progression. The patient also presented with a pituitary tumor recurrence, which was treated by stereotaxic radiotherapy. He died five years after the initial diagnosis of RCC and 30 months after the diagnosis of the pituitary metastasis.  CONCLUSIONS There are no standardized treatment guidelines for management of pituitary metastases. Pituitary surgery plays a role in symptom palliation, and it does not have any relevant impact on survival. Exclusive radiotherapy or stereotaxic radiotherapy could be an alternative to surgery in patients whose general condition is poor or who have concomitant extra-pituitary metastases.
authors.affiliation: Division of Medical Oncology, Regional Hospital Center (CHR) Metz-Thionville, Ars-Laquenexy, France.
authors.forename: Chloé
authors.initials: C
authors.lastname: Wendel
authors.affiliation: Division of Medical Oncology, Regional Hospital Center (CHR) Metz-Thionville, Ars-Laquenexy, France.
authors.forename: Marco
authors.initials: M
authors.lastname: Campitiello
authors.affiliation: Division of Medical Oncology, Regional Hospital Center (CHR) Metz-Thionville, Ars-Laquenexy, France.
authors.forename: Francesca
authors.initials: F
authors.lastname: Plastino
authors.affiliation: Division of Medical Oncology, Regional Hospital Center (CHR) Metz-Thionville, Ars-Laquenexy, France.
authors.forename: Nada
authors.initials: N
authors.lastname: Eid
authors.affiliation: Division of Radiology, Regional Hospital Center (CHR) Metz-Thionville, Ars-Laquenexy, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Hennequin
authors.affiliation: Division of Radiotherapy, Regional Hospital Center (CHR) Metz-Thionville, Ars-Laquenexy, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Quétin
authors.affiliation: Division of Medical Oncology, Regional Hospital Center (CHR) Metz-Thionville, Ars-Laquenexy, France.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Longo
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000077784:Axitinib; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy*; D018450:Disease Progression; D000068338:Everolimus / Q000008:administration & dosage; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage; D007191:Indazoles / Q000008:administration & dosage; D007211:Indoles / Q000008:administration & dosage; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D019635:Neurosurgical Procedures / Q000379:methods; D009536:Niacinamide / Q000008:administration & dosage / Q000031:analogs & derivatives; D010671:Phenylurea Compounds / Q000008:administration & dosage; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy*; D011758:Pyrroles / Q000008:administration & dosage; D018714:Radiotherapy, Adjuvant / Q000379:methods; D000077157:Sorafenib; D000077210:Sunitinib; D016896:Treatment Outcome
chemical_list: D007093:Imidazoles; D007191:Indazoles; D007211:Indoles; D010671:Phenylurea Compounds; D011758:Pyrroles; D009536:Niacinamide; D000068338:Everolimus; D000077157:Sorafenib; D000077784:Axitinib; D000077210:Sunitinib