Neuro-ophthalmological findings of pituitary metastasis: Case series from a single center and review of the literature

Abstract

When pituitary metastasis (PM) invades the pituitary gland, it leads to impaired endocrine function and compression and infiltration of surrounding tissues, causing a series of clinical alterations. We presented seven patients with PM evaluated at neuro-ophthalmologic clinic and reviewed neuro-ophthalmological findings of 44 cases with PM in the English literature from 1979 to December 2022. The mean age at diagnosis was 58.1 years, and 45.1% were male. The mean latency period from primary cancer to the diagnosis of PM was 57.6 months. PM is the only presenting sign of malignancy in 11.8% of patients. The mean time from the visual disturbance to the diagnosis of PM was 96.3 days. Visual acuity decreased in 72.5% and 60.8% of cases with visual field defects. 74.2% exhibited a pattern of temporal field defect respecting the vertical meridian. Isolated ophthalmoplegia was found in 37.3% of patients. The most common ocular motor nerve palsy was unilateral III nerve palsy. Breast cancer was the most common primary malignancy. 84.6% entirely or partially relieved the neuro-ophthalmic symptoms after treatment. 51% of patients were alive during a mean follow-up period of 11 months. The mean survival duration was within six months in 65% of deceased patients. For elderly patients with a pituitary tumor, PM should be on the list of differential diagnoses for those with visual impairment, especially ocular motor nerve palsy, even if diabetic insipidus is not present, with or even without a history of malignancy, regardless of the primary tumor site.

Keywords

• Neuro-ophthalmology
• Pituitary metastasis
• Visual field defect
• Vision loss