The work is based on the results of observation and treatment of 73 patients with metastatic pituitary lesions (metastases to the pituitary gland, PM). Among patients with histological diagnosis (I group) 23 had oncologic history (65.7%). In 12 cases (34.3%), the diagnosis of pituitary lesion prior to surgery was made on the basis of neuroimaging methods, but no history of cancer was available. In the other 38 patients (52.1%), PM was diagnosed based on neuroimaging findings, clinical manifestations, clinical course, and and a combination of these factors. These histologically unverified tumors were classified as group II. The standard set of laboratory tests included blood test, urine test and biochemical blood tests, gormonal blood tests using unified methods. Somatic and neurological status were assessed by conventional indicators and syndromes. The long period from the diagnosis of cancer to the moment of pituitary metastasis verification showed a relatively late appearance of metastasis to the pituitary gland. PMs appear in the late period of cancer, but are characterized by rapid growth rates. Noteworthy is the high proportion of patients with asymptomatic course of pituitary metastasis in our series, such patients had a significant numerical advantage in the group of patients who were not exposed to surgery. Among our observations, there was a strong correlation between the localization of the primary lesion, which led to pituitary metastasis and the sex of patients: men had lung cancer and women had breast cancer. Another demographic feature of pituitary metastasis is their emergence in persons of mature and advanced age. Clinical course in patients with pituitary metastasis was characterized by a high frequency of visual disturbances, oculomotor disorders, endocrinological symptoms such as diabetes insipidus, hypopituitarism. Clinical symptoms were due to rapid growth, large size of MP, frequent spread into the cavernous sinus, and such topographic features as lesions of the posterior pituitary and stalk. Diagnosis of pituitary metastasis is complex, as none of the diagnostic methods has exceptional specificity. All patients in our sample were examined by MRI, both in rutine mode and with intravenous contrast. Among 35 patients, contrast enhancement was good in 31 cases, while 4 (11.4%) tumors were poorly enhanced. In the postoperative period in patients with hypopituitary disorders present before surgery, there was no change in the severity of pituitary insufficiency. Deterioration of endocrine status was associated with the onset of hypothyroidism, hypocorticism and was observed in 3 patients. In the postoperative period, diabetes insipidus appeared in 4 patients in whom it was absent. In 20 patients who had diabetes insipidus prior to surgery, the dynamic of this symptom wasn’t shown. Of the 18 patients operated on for pituitary metastasis in the early postoperative period, the quality of life, assessed according to the Karnovsky scale > 80, did not deteriorate in 17 patients, and in 1 quality of life deteriorated. Of the 17 patients in the early postoperative period whose quality of life before surgery was less than 80 points according to the Karnovsky scale, the condition did not change in 5 patients, in 12 the KPS improved. Performed statistical analysis to compare KPS in the group of our patients in the preoperative and postoperative periods (comparing the average of two dependent samples) showed the statistical significance of improving the quality of life. Analysis of the results in patients with pituitary metastasis showed increase in the overall survival in operated patients compared with non-operated patients, although there was, but was not statistically significant. The result of the study indicates that the life expectancy of cancer patients with pituitary metastasis is primarily determined by the control of the main cancer disease. The validity of impressions, surgery, and removal rates can significantly improve the quality of life in patients with pituitary metastasis. Especially when using modern minimally invasive endoscopic techniques. Overall, better results can be achieved in younger patients, women, with a controlled major cancer, with good postoperative neurological status and quality of life, in which full removal of pituitary metastasis is performed. The positive dynamic of quality of life in patients with pituitary metastasis were primarily related to the regression of visual disturbances, local pain syndrome, to a lesser extent, oculomotor disorders. There is no regression or severity of hormonal disorders such as diabetes insipidus and hypopituitarism after surgery. Clinical implementation of the proposed therapeutic tactics and methods of surgery for metastatic pituitary lesions will improve the treatment outcomes of patients with this pathology.
