Pituitary metastasis as an endocrine–neuro-ophthalmologic emergency: clinical red flags and outcomes from a contemporary tertiary-center series

PURPOSE: To characterize the clinical presentation, endocrine phenotype, and outcomes of pituitary metastasis in a contemporary tertiary-center cohort, with emphasis on clinically actionable diagnostic red flags. METHODS: We conducted a retrospective single-center case series of 14 consecutive patients diagnosed with pituitary metastasis between 2010 and 2025. Presenting manifestations, endocrine features, radiologic findings, primary tumor origin, treatment patterns, and overall survival were assessed. In patients without histopathologic confirmation, diagnosis was established using the validated clinicoradiologic model proposed by Yuzkan et al. RESULTS: Median age was 52.5 years, and 71.4% of patients were women. Hypopituitarism (64.3%), arginine vasopressin deficiency (50.0%), and visual impairment (50.0%) were frequent at presentation. One patient presented with sudden bilateral visual loss and hemodynamic instability, mimicking an apoplexy-like sellar emergency. Breast cancer was the most common primary tumor (28.6%). Serum prolactin levels, available in 11 patients, were uniformly below the range typically expected for macroprolactinoma despite large sellar masses. Histopathologic confirmation was obtained in 35.7% of cases, whereas the remainder fulfilled high-likelihood clinicoradiologic criteria. Median overall survival after pituitary metastasis diagnosis was 6.5 months, and 92.9% of patients died during follow-up. CONCLUSION: Pituitary metastasis frequently presents with combined endocrine dysfunction and neuro-ophthalmologic compromise, occasionally as an acute sellar emergency. In oncologic patients with sellar lesions, the combination of AVP-D, visual deterioration, and non-prolactinoma-range hyperprolactinemia should raise suspicion for pituitary metastasis and prompt urgent endocrine and local evaluation.