MON-092 - Pre- and Postoperative Clinical and Endocrinological Findings of 56 Surgical Treated Patients with Pituitary Metastases

Introduction
Pituitary metastases (PM) are rare, resulting in limited clinical experience regarding diagnosis, prognosis, and the benefit of surgical treatment, particularly with respect to endocrine outcomes. This study analyzes a consecutive patient cohort to characterize clinical presentation and assess the impact of surgery on neurological and endocrinological symptoms, aiming to support earlier diagnosis and individualized treatment strategies.

Material and Methods
Fifty-six patients with histologically confirmed PM treated between 1982 and 2022 were identified from a prospectively maintained sellar tumor database at a single center. Pre- and postoperative clinical, ophthalmologic, and endocrinologic findings were retrospectively analyzed. Postoperative data were obtained from clinical follow-up. Statistical analyses were performed to characterize perioperative findings and identify significant differences.

Results
More than 90% of patients were symptomatic at presentation, most commonly with visual impairment (92.3%). Suprasellar extension (43.0%) and cavernous sinus invasion (41.1%) were frequent. Global anterior pituitary insufficiency was present in 13.8% of patients, most affecting the gonadotropic axis (69.3%), followed by corticotropic (34.2%) and thyrotropic (30.6%) dysfunction. Hyperprolactinemia was observed in 39.5% of cases, while diabetes insipidus was rare (7.1%). Surgery was mainly performed via a transsphenoidal approach (58.8%). Surgical intervention led to a significant decrease in prolactin levels (p = 0.014), whereas postoperative new deficiencies were observed in growth hormone (p = 0.028), luteinizing hormone (p = 0.048) and free T3 (p = 0.003). Abducens nerve palsy improved more often than oculomotor nerve palsy (42.9% vs. 29.4%), while visual impairment demonstrated comparable rates of postoperative improvement and deterioration. Except for abducens nerve palsy, all evaluated symptoms included cases of newly developed postoperative deficits. Overall, visual function was affected postoperatively in 3 of 56 patients (5.4%). Breast cancer in women (23.2 %) and renal cell cancer in men (14.3 %) were the most common primary malignancies, with PM diagnosed a mean of 8.1 years after the initial cancer diagnosis. In 23.2% the symptomatic sellar lesion led to the first diagnosis of the underlying malignancy.

Conclusion and Discussion
PM typically present with visual impairment and anterior hypopituitarism. Surgery is mainly justified for visual decompression, whereas endocrine deficits rarely improve and may worsen postoperatively. Visual improvement and prolactin reduction reflect effective tumor debulking, while overall outcomes remain largely determined by the underlying malignancy.

This study was supported by a grant of the Förderverein Neurochirurgische Forschung an der Universität Erlangen-Nürnberg e.V..

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