Breast Cancer Metastasis to the Pituitary Presenting With Apoplexy

A 66-year-old female was referred to the skull base surgeons with diplopia, worsening bilateral visual disturbances, headaches, polydipsia, and polyuria. For the past 17 years, she had been treated for recurrent breast cancers and sigmoid colon carcinoma surgically and radiologically with aromatase inhibitors. MRI scans indicated significant metastases in her liver, bones, breast, pituitary, and left orbit with infiltration into the left optic nerve. During the investigations, the proximity of the large lesion to the carotid arteries and optic nerves had to be taken into account, while balancing the risk of stroke and further visual loss from surgery and her current worsening symptoms. Due to the terminal nature of the disease and atypical presentation of diplopia, a multidisciplinary discussion was conducted to decide the best course of treatment to provide symptomatic relief. Afterward, the surgical resection of the lesion was performed successfully with no complications. This report highlights the fact that metastatic cancers can have unusual and atypical presentations of existing diseases, such as sixth nerve palsy seen in addition to the typical symptoms of pituitary adenoma. Furthermore, radiological evidence in identifying affected structures is also important in identifying the etiology of the lesion based on previous cases. Lastly, the report emphasizes the significance of multidisciplinary discussions in determining the most appropriate management plan to ensure symptomatic relief in terminal diseases.