Clinical Presentation of Patients with Pituitary Tumour and its Correlation to Magnetic Resonance Imaging: An Observational Study

Abstract

Introduction: Pituitary tumours are common intracranial tumours affecting mainly the 4th to 7th decade of life. A detailed understanding of these pituitary tumour patients, especially regarding their clinical and MRI profile would help in its early detection.It also help in deciding upon further management (medical or surgical or radiation), thus helping in improved outcome. Aim: To find out the common clinical presentations and the MRI findings of pituitary tumour. Materials and Methods: A cross-sectional observational study was carried out among 88 patients admitted with diagnosis of pituitary tumour in a tertiary care center from 1st June 2018 to 30th September 2019. The study involved initial clinical assessment followed by MRI brain of all the patients included in the study. To find out relationship between imaging findings and clinical symptoms statistical analysis was done. Results: The most common clinical presentations were headache in 55 patients (commonly throbbing type in frontal region) and visual field defects in 52 patients (uni/bitemporal hemianopia). A 51 (58%) patients had suprasellar extension and 35 (39.8%) patients had tumour already progressed to parasellar extension stage at time of detection of adenoma. Most of the patients detected with pituitary tumours (i.e., 63.6%) had grade two invasion. Four incidental adenomas were detected and none of them had parasellar extension. Among 35 patients with parasellar extension, 27 (77.1%) patients had visual disturbance. In 45 (51.1%) patients without parasellar extension had no sellar floor involvement. Visual disturbance was significantly associated with the parasellar extension of the tumour. Conclusion: Headache and visual field defects were the most common clinical presentation among pituitary tumour patients. Patients with tumours having parasellar extension are more likely to have visual disturbance than with patients having only suprasellar extension. Radiologically, pituitary tumours tend to expand only into suprasellar area, then it involves the parasellar area, followed by sellar floor which occurred last.