Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The technique of "chemical hypophysectomy" was modified for the management of pain due to metastatic cancer. Using stereotaxic control, a needle is introduced via the nose into the sella turcica. Absolute alcohol is then injected into the pituitary. Of 13 patients who had severe uncontrollable pain, 11 obtained marked symptomatic relief. The longest follow-up period to date is seven months, with results persisting. Sequelae are those associated with destruction of the pituitary gland, the most significant being diabetes insipidus. Several cerebrospinal fluid leaks prompted us routinely to instill alpha-ethyl cyanoacrylate to seal the sella floor. Three patients had slight extraocular nerve palsies. There was no death related to the procedure.
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PMID:Treatment of diffuse metastatic cancer pain by instillation of alcohol into the sella turcica. 31 6

Diabetes insipidus, resulting from metastatic involvement of the neurohypophysial system, is a rare complication of breast cancer. This review examined the clinical features, metastatic pattern, and radiological and postmortem findings of 39 breast cancer patients with this complication. All patients had polyuria and polydipsia, and all had evidence of advanced metastatic breast cancer. A high incidence of meningeal carcinoma carcinomatosis and/or sellar metastases was observed. In view of the anatomical proximity of the posterior pituitary to the dura mater and the sella turcica, our findings suggest that metastases to the neurohypophysis can occur not only as a result of hematogenous dissemination of malignant cells, but also from direct tumor extension and/or invasion from adjacent structures. Although satisfactory symptomatic relief can be obtained with vasopressin tannate, complete resolution of the diabetic insipidus syndrome was evident only in those patients who had achieved control of the underlying breast disease.
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PMID:Diabetes insipidus and breast cancer. 47 18

Metastatic carcinoma was found in 9 pituitary glands (24%) of 37 patients undergoing transphenoidal hypophysectomy for diffuselly metastatic breast carcinoma. In all cases the preoperative neurological examination was negative, as were neuroradiological studies, including skull X-ray, tomograms of the sells turcicabrain scan, and angiography. Diabetes insipidus, however, was seen more frequently in patients with pituitary metastasis preoperatively (3 of 9) and postoperatively (8 of 9). Four of the nine patients with pituitary metastasis developed severe diabetes insipidus, which continued more than one month, while similar severe disease was seen in three of twenty-seven cases with no pathological evidence of pituitary metastasis. The prognosis in patients with pituitary metastasis was poor, with seven of the nine dying with an average survival of eighteen months. Pathological studies disclosed metastatic lesions in the anterior lobe (78%), posterior lobe (44%), and stalk (11%). The study emphasized that pituitary metastases, usually considered to be rare, occurred in 24% of patients with diffusely metastatic breast carcinoma. Such metastases correlate with the development of severe diabetes insipidus and with poor prognosis.
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PMID:[Metastatic breast carcinoma in the pituitary gland (author's transl)]. 63 55

A 38-year-old woman complained of headache, visual impairment, and diabetes insipidus for 18 months prior to rapid onset of Cushing syndrome and amenorrhea. An autopsy disclosed a pituitary carchinoma invading the right cavernous sinus and two liver metastases. The tumor cells were chromophobic and agranular, with scarce polymorphism and rare mitoses. A review of the literature showed that the association of Cushing syndrome to pituitary carcinomas increases in direct proportion to the occurence of metastases. Such association was noted in almost half of the reported cases of pituitary carcinomas with extracranial dissemination.
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PMID:Pituitary carcinoma with liver metastases and Cushing syndrome. Report of a case. 111 93

Experience with 50 women undergoing extracranial transethmoidal-sphenoidal hypophysectomy for metastatic breast carcinoma with 12-month follow-up showed an objective remission of metastases after hypophysectomy in 58% of patients. The highest incidence of remission following the operation occurred in those women with only osseous metastases (83%) or with previous remission to both therapeutic oophorectomy and androgen administration (86%). No patient with primary central nervous system metastases, only one of ten with hepatic metastases, and none who had failed to respond to both oophorectomy and exogenous androgen administration experienced remission after hypophysectomy. The operative approach to the pituitary was via a periorbital incision, the posterior ethmoid cells, and the sphenoid sinus. Cerebrospinal fluid rhinorrhea occurred in three early patients, and has been successfully avoided in later ones by a fascia lata graft. Diabetes insipidus, seen in 13 patients, and extraocular palsies, seen in two, were transient.
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PMID:Hypophysectomy in metastatic breast cancer. 111 32

Clinical and pathologic features of 88 cases of carcinoma metastatic to the pituitary gland were reviewed. In 61 (69.3%), metastases were localized either in the posterior lobe alone or in the posterior and anterior lobes together; only 12 (13.6%) involved the anterior lobe alone. Diabetes insipidus was present in 6 patients (6.8%), one of whom also had clinical panhypopituitarism due to metastatic tumor and necrosis in the anterior pituitary lobe. Breast and lung were the most frequent primary sites in women and men, respectively. Sixty-four (72.7%) of these glands were grossly normal at necropsy. Metastases to the pituitary gland occur more frequently in the posterior lobe than in the anterior lobe, and my ve reflected clinically by diabetes insipidus in patients with diseminated carcinoma. Clinical panhypopituitarism is a rare accompaniment of anterior lobe involvement.
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PMID:Clinicopathologic review of 88 cases of carcinoma metastatic to the putuitary gland. 120 49

The authors report the case of a young woman with advanced breast cancer who developed diabetes insipidus due to pituitary involvement and also gastric metastases. This patient had a normal brain CT scan. Gastric metastases were diagnosed when she was operated for a perforated gastric ulcer. Although very rare, and even if the brain CT scan is normal, pituitary metastases should be diagnosed in the presence of suggestive clinical symptoms. Abdominal pain also warrants investigation in these patients in an early attempt to document any possible gastric metastases.
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PMID:[Hypothalamo-hypophyseal and gastric metastasis of a breast neoplasm. Clinical case and a review of the literature]. 136 53

Magnetic resonance imaging (MRI) has been established as a valuable imaging modality in the evaluation of pituitary disorders. We describe three women with known carcinoma of the breast, who presented acutely with biochemically proven diabetes insipidus (DI), in whom MRI was used as the primary investigative tool. The patients were studied using a 1.5T superconducting system, with gadolinium enhancement in two cases. All three had thickened pituitary stalks and two had complete loss of the normal high signal from the posterior lobe of the pituitary gland. Two also had enlargement of the anterior pituitary gland. One subject was also noted to have other metastases to the brain. All three had multiple secondary deposits elsewhere in the body and one had metastases to the clivus but without evidence of extension to the pituitary fossa. DI is uncommon in systemic cancers and anterior pituitary dysfunction much more so, due to the separate blood supply of the two lobes. Thickening of the stalk has not been found frequently in large autopsy series. In the clinical context of DI in a patient with a known primary tumour the loss of high signal from the posterior lobe and stalk thickening are indicative of infiltration by metastases. A pituitary mass or metastases to adjacent bones are not necessary for diagnosis.
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PMID:MRI in diabetes insipidus due to metastatic breast carcinoma. 139 23

Seven patients with metastatic tumour in the pituitary-hypothalamic axis were investigated by MRI. The main clinical problems were diabetes insipidus (5 cases) and general pituitary dysfunction (2 cases). No patient had visual or oculomotor symptoms. In 6 of the 7 patients the primary malignant tumour was known, but no patient had symptoms from the primary tumour; 1 had symptoms from metastases in locations other than the pituitary gland. In one patient no primary tumour was known. MR detection of a second, clinically silent, 5 mm lesion in the posterior cranial fossa initiated the search for primary tumour. MRI showed purely suprasellar tumours in 3 patients and intra- and suprasellar tumours in 4. The latter were dumbbell lesions with only a small bridge of tissue connecting the intra- und suprasellar portions. Six of the 7 suprasellar tumours seemed to be in the infundibular recess of the third ventricle; in 5 the infundibulum was visible as an enhancing linear structure at the postero-inferior border of the tumour. The pituitary fossa was normal in all cases.
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PMID:Metastases to the pituitary--hypothalamic axis. An MR study of 7 symptomatic patients. 160 11

Hypothalamo-hypophyseal metastases are still a relatively unfamiliar entity. Mostly they are confirmed by autopsy. Rear clinical manifestations are presented by diabetes insipidus. In general, patients with endocrine breast carcinoma metastases are young, premenopausal women, with great tumour burden and widely disseminated tumor. We report 54-year-old woman with diabetes insipidus caused by solitary breast carcinoma metastasis, eight years after primary tumour was diagnosed. The operative and radiation therapy were effective.
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PMID:[Diabetes insipidus as a sequela of metastatic breast carcinoma]. 178 19


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