Walsh & Hoyt: Metastases to the Sella Turcica and Pituitary Gland

Diplopia or visual loss with bitemporal field defects may also represent metastatic disease to the sellar region. Not surprisingly, lung and breast are the most common primary sites, but many pathologies are encountered. Occasionally, the metastasis is to a preexisting pituitary adenoma. A clinical picture that suggests metastatic disease is diabetes insipidus (unlikely to be present with a pituitary adenoma alone preoperatively) accompanied by a rapidly progressing painful ophthalmoplegia. Surgical decompression and radiation may have palliative value, improving both pain and vision. Some tumors, such as prostatic adenocarcinoma, may respond to chemotherapy with visual improvement.