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Solitary pituitary metastasis from HER2-positive breast cancer. The introduction of anti-HER2 therapy with trastuzumab has seen an increase in frequency of central nervous system metastasis as the site of first recurrence. Here, we present a rare case of a 63-year-old woman who presented with an isolated breast carcinoma pituitary metastasis 5 years following treatment for a high-risk breast cancer. This report underscores the changing nature of HER2-positive disease in the post-trastuzumab era.