Pituitary metastasis revisited: a retrospective single-center experience with diagnostic challenges and surgical nuances. Illustrative cases.

backgroundPituitary metastases represent approximately 1% of all pituitary tumors and are associated with a poor prognosis. Although rare, early diagnosis and treatment are critical to limit rapid clinical decline. Because of their rarity, published data remain limited. The authors report their institutional experience at The Ottawa Hospital, focusing on clinical and radiological presentation, surgical management, adjuvant therapy, and outcomes. OBSERVATIONS: The authors retrospectively reviewed the cases of adult patients undergoing endoscopic endonasal skull base surgery for pituitary metastases between 2016 and 2025. Inclusion criteria were histopathological confirmation and complete clinical data. Four patients (mean age 57 years) were identified; 3 had known primary malignancies. All of the patients had cranial nerve (CN) deficits. Headache was the most common symptom, followed by visual disturbance; diabetes insipidus occurred in 2 patients. Imaging showed bone erosion in all cases and cavernous sinus invasion in 1 patient. All patients underwent endoscopic resection. Tumors were adherent and highly vascular, requiring meticulous microsurgical dissection and hemostatic agents. Postoperative complications were minimal, with one CSF leak. All patients received adjuvant radiotherapy. CN improvement occurred in 3 patients. Three patients died, with a mean survival of 6.3 months postdiagnosis. LESSONS: Pituitary metastases are associated with rapid clinical deterioration and poor survival. Multidisciplinary management and further research are needed to improve outcomes. https://thejns.org/doi/10.3171/CASE26115.