Salma Ismail Daffa

Background Pituitary metastases (PM) are rare intracranial secondary tumors, most often arising from breast and lung primaries. They are clinically significant due to their association with advanced systemic malignancy and potential to cause visual, neurological, and endocrinological morbidity. Conventional therapies such as surgery and fractionated radiotherapy have limited efficacy or high morbidity. Stereotactic radiosurgery (SRS) has emerged as a minimally invasive alternative, but available evidence is limited to small, heterogeneous series. Objective To evaluate the effectiveness and safety of SRS in patients with PM by synthesizing data on tumor control, survival outcomes, progression-free survival (PFS), and treatment-related morbidity. Methods A systematic review and meta-analysis were performed according to PRISMA guidelines. PubMed, Embase, Scopus, Web of Science, and Cochrane Library were searched through June 2025. Eligible studies included patients with radiologically or histologically confirmed PM treated with SRS. Outcomes of interest were local tumor control, survival, PFS, radiological response, and complications, including hypopituitarism, optic neuropathy, and radiation necrosis. Data were pooled using a random-effects single-arm meta-analysis model. Results Six retrospective case series comprising 142 patients were included. Pooled local control following SRS was 89% (95% CI 75–96%). Six-month PFS was 97% (95% CI 83–100%). One- and two-year survival rates were 53% (95% CI 32–73%) and 40% (95% CI 15–72%), respectively. Tumor regression occurred in 34% and stable disease in 33%, while only 7% demonstrated progression. Treatment-related morbidity was low: new-onset hypopituitarism (1%), optic neuropathy (2%), and radiation necrosis (1%). Conclusion SRS provides effective and durable local control of pituitary metastases with a favorable safety profile and low rates of treatment-related toxicity. Despite the poor systemic prognosis associated with PM, SRS offers meaningful intracranial disease control and symptom relief, particularly in well-selected patients with stable systemic disease. Larger prospective, standardized studies are needed to further clarify long-term endocrine and neurological outcomes.

Background/Objectives: Iron-deficiency anemia (IDA) is a common condition in children and is frequently attributed to nutritional causes. However, gastrointestinal (GI) pathology may be present even in the absence of overt GI symptoms. The diagnostic value of endoscopic evaluation in asymptomatic pediatric patients with IDA remains debated. This systematic review aimed to synthesize available evidence on endoscopic and histologic findings in asymptomatic children with IDA and to assess their clinical implications. Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines, and the protocol was registered in PROSPERO. MEDLINE (via PubMed) and Scopus were searched for studies involving children and adolescents (0–18 years) with confirmed iron-deficiency anemia and no gastrointestinal symptoms who underwent endoscopic evaluation. Results: Six studies met the inclusion criteria, comprising a total of 455 pediatric patients. Upper GI endoscopy was the most commonly performed procedure. Clinically significant findings were frequently identified, including histologic features consistent with celiac disease, Helicobacter pylori-associated gastritis, and chronic inflammatory gastric changes. Histologic abnormalities were often present despite minimal or absent macroscopic endoscopic findings. The diagnostic yield of endoscopy was particularly high in older children and adolescents and in those with severe or refractory IDA. Conclusions: This systematic review demonstrates that asymptomatic children with IDA may harbor significant GI pathology detectable by endoscopic and histologic evaluation. These findings support the consideration of targeted endoscopic assessments in selected pediatric patients with unexplained or persistent IDA, even in the absence of GI symptoms.