A 53-YEAR-OLD MAN had a 1-month history of headaches, lethargy, decreased libido, and increased thirst. Subsequently, he developed diplopia, bitemporal hemianopsia, and a right third nerve palsy. He recently had 1 bout of hematuria following exercise. His physical examination was otherwise unrevealing. His medical, surgical, and family history were unremarkable. Endocrine testing revealed panhypopituitarism and diabetes insipidus (DI); urinalysis showed microscopic hematuria. Magnetic resonance imaging demonstrated an enhancing, invasive sellar and parasellar mass (Figure 1, A-C). Transsphenoidal decompression and subtotal resection were performed, with resolution of his headache and improvement in his visual field deficits and diplopia. Diabetes insipidus and hypopituitarism persisted. A clear cell carcinoma was identified histologically (Figure 1, D-E). Results of a workup revealed a 6-cm solid mass in the right kidney, which was resected. The patient received fractionated radiotherapy to the parasellar region, with stabilization of his residual metastatic pituitary disease. He died of disseminated systemic disease at 12 months.
Weil RJ. Pituitary Metastasis. Arch Neurol. 2002;59(12):1962-1963. doi:10.1001/archneur.59.12.1962