PITUITARY METASTASIS FROM BLADDER UROTHELIAL CARCINOMA: A RARE CASE REPORT AND A REVIEW OF THE LITERATURE ON PITUITARY METASTASIS OVER THE LAST DECADE.

Objective: Pituitary metastases are a rare entity, account for 1% of all intracranial metastases. This study aims to report a pituitary metastasis (PM) from bladder cancer and to provide a review of PM characteristics. Method: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed using PubMed for studies published between January 2014 and January 2024. Results: One hundred twenty eight patients (66 females, 62 males) were identified in the literature over the past decade. Median age was 61 years. The most common primary malignancies were lung cancer (24.2%) and breast cancer (21.1%). The most common symptom was visual impairment (46.1%). Deficiencies in adrenocorticotropic hormone (ACTH), thyroid stimulating hormone (TSH) and gonadotropin hormones were diagnosed in 46%, 40.4%, 35% of cases, respectively. Diabetes insipidus (DI) was present in 33.6% of cases and panhypopituitarism was present in 21.9% of cases. PM management included transsphenoidal surgery alone (25%), transsphenoidal surgery combined with radiotherapy (16.4%), radiotherapy alone (10.2%), or observation without intervention (10.9%). The median survival following the diagnosis of PM was 6 months. Conclusion: While PM remain a infrequent entity, prolonged lifespan of cancer patients has led to increased detection. Patients frequently present with visual disturbance,diabetes insipidus and anterior pituitary hormone deficiency. No standardized treatment guidelines exist. Surgery and/or radiotherapy are used as palliative modalities rather than curative treatments. The prognosis is generally poor and is mostly related to the stage and type of the primary tumor.