Evaluation of Sellar Masses

Abstract

The clinical presentation of a patient with a sellar mass can include signs and symptoms of hormonal excess, hormonal deficiency, or of the mass itself such as vision loss or headache. Alternatively a sellar mass may be discovered incidentally on brain imaging performed for an unrelated reason. Autopsy and radiology studies suggest the prevalence of incidentally found pituitary masses to be approximately 10 % of the population (Molitch, Endocrinol Metab Clin North Am 37:151–171, 2008). Clinically significant pituitary lesions are diagnosed in 1 in 1,000 people (Bancos et al., Best Pract Res Clin Endocrinol Metab 26(1):9–19, 2012). Although a wide variety of diseases can manifest as sellar or parasellar masses (Table 5.1), the vast majority of clinically apparent and incidentally found lesions are pituitary adenomas, or Rathke’s cleft cyst (Orija et al., Best Pract Res Clin Endocrinol Metab 26(1):47–68, 2012). The effects of excess hormonal secretion (prolactin (PRL), growth hormone (GH), corticotropin (ACTH), thyrotropin (TSH)) from functioning pituitary adenomas can lead to significant morbidity and increased mortality. Hypopituitarism can be a consequence of any mass lesion in the sellar or parasellar region.