Pituitary Metastases From Differentiated Thyroid Cancers: A Systematic Review

Area of Science:

• Endocrinology
• Oncology
• Neurosurgery

Background:

• Pituitary metastasis (PM) from differentiated thyroid cancer (DTC) is an exceptionally rare clinical event.
• PM can significantly impact patient prognosis and treatment outcomes.
• Understanding the characteristics and outcomes of PM from DTC is crucial for improving patient care.

Purpose of the Study:

• To systematically review and assess the clinical characteristics of patients with pituitary metastasis originating from differentiated thyroid cancer.
• To evaluate the outcomes and survival patterns in patients diagnosed with PM from DTC.
• To identify common presentations, endocrine abnormalities, and treatment modalities for PM from DTC.

Main Methods:

• A systematic literature review was conducted across PubMed, Embase, and Scopus databases.
• Publications on PM and DTC histologic types (papillary, follicular, Hurthle cell) from 1967 to 2022 were included.
• Survival time was calculated from the initial treatment of PM to death or last follow-up, adhering to PRISMA guidelines.

Main Results:

• Twenty-five articles reported 27 cases of PM from DTC, predominantly in females (66.7%) with papillary thyroid cancer (55.6%).
• Common symptoms included headache, nausea, vomiting, and visual disturbances (44.4%), while diabetes insipidus was rare (7.4%).
• Median survival was 12 months, with 30% mortality and only 33.3% achieving complete symptom resolution; hyperprolactinemia was the most frequent endocrine abnormality (63.2%).

Conclusions:

• Pituitary metastasis from DTC is rare, with Hurthle cell cancer showing the least association.
• Diabetes insipidus is an uncommon initial presentation, and complete symptom resolution is infrequent.
• While older age may correlate with better survival, larger studies are needed to confirm this and to identify survival predictors and optimal treatment strategies.