Intrasellar Mass Research Articles

Smoking, polyuria and impaired vision

The pituitary gland can be involved in a variety of medical conditions, including metastatic tumors. Metastases to the pituitary gland, although absolutely rare, more commonly affect the posterior pituitary lobe and so frequently present with diabetes insipidus. We report on a 48-year-old male heavy smoker patient suffering from sudden onset of polyuria and persistent thirst. Laboratory results revealed central diabetes insipidus. Computed tomography (CT) scan of the brain showed a mass located in the sella turcica and in the suprasellar region. CT scan of the chest showed a mass in the right superior lobe with mediastinal lymphadenopathy, with bronchoscopy and biopsy features of pulmonary adenocarcinoma. The patient received radiotherapy on the pituitary gland and adjuvant chemotherapy, and as intrasellar and suprasellar mass decreased in size, urinary output was accordingly reduced. Therefore, is that in patients with risk factors for cancer and sudden onset of diabetes insipidus pituitary metastasis should be taken into account in differential diagnosis.

Acromegaly with moderate hyperprolactinemia caused by an intrasellar macroadenoma

A 31-year-old woman presented 12 months after discontinuing the oral contraceptive pill with progressive headache to her primary-care physician. She had previously presented with irregular menses to her obstetrician-gynecologist 4 months after discontinuing the oral contraceptive pill. Her serum prolactin levels were 153 microg/l and a pituitary MRI revealed a 13 mm intrasellar mass consistent with an adenoma. The patient was given 0.5 mg cabergoline twice weekly, and after 6 weeks her prolactin levels fell to 31 microg/l. After 6 months, however, she complained of persistent frontal headache and a repeat MRI revealed that the adenoma had increased in size to 16 mm. The patient was referred to an endocrinologist for further evaluation. Serum insulin-like growth factor 1 levels and growth hormone levels measured 2 h after ingestion of 75 g of oral glucose. Acromegaly and hyperprolactinemia caused by a mixed-cell adenoma, secreting growth hormone and prolactin. Trans-sphenoidal surgery followed by medical therapy with 20 mg intramuscular octreotide-LAR monthly.

A case of reversed pituitary dysfunction with intrasellar mass

Hypopituitarism can be caused by tumor, inflammation, granuloma and injuries. Once pituitary function is disturbed, hormone replacement therapy is necessary for the remaining life span in most cases. We have experienced a rare case of a unique intrasellar mass associated with pituitary dysfunction in which both spontaneously reversed. A 61-yr-old woman developed hypoadrenalism and central diabetes insipidus (cDI). Magnetic resonance (MR) imaging revealed a lobular, strong hypointense lesion with spotty signal in the middle of the hypophysis. This spotty lesion showed isointensity on T1- and high-intensity on T2-weighted MR images. The spotty signal as well as the normal pituitary lobe were enhanced by the administration of gadolinium. As replacement therapies for hypoadrenalism and cDI, 10 mg of hydrocortisone and 2.5 microg of desmopressin acetate were prescribed. Three months later, slight shrinkage of intrasellar mass and spontaneous improvement of pituitary functions were found. Hydrocortisone was then discontinued. Furthermore, because polyuria and polydipsia were improved nine months later, desmopressin acetate was stopped. Currently, the intrasellar mass continues to shrink, and the patient shows no symptoms without medication. Based upon the unique features of MR images, we suspect that the origin of the mass is an intrasellar hemangioma.

Craniopharyngioma in a Female Adolescent Presenting with Symptoms of Anorexia Nervosa

Tumours of the central nervous system mostly present with neurological symptoms and signs of intracranial hypertension. Several reports of cerebral tumors in adolescents outline initial symptoms of anorexia and emaciation, leading to the diagnosis of anorexia nervosa. We report on a 15.5-year-old girl with a craniopharyngioma. The girl had a 2 year history of weight loss, dystrophy, no onset of puberty, and a 6 year history of headache. These symptoms had led initially to the clinical diagnoses of migraine and anorexia nervosa, since unenhanced computed tomography of the brain was normal. At presentation, physical examination showed short stature (height SDS - 3.6) and Tanner stage I. Bone age delay was about four years. Laboratory analyses showed hypopituitarism. The diagnosis of craniopharyngioma was made by repeated imaging, depicting an intrasellar and parasellar mass, which was totally removed by neurosurgery. Hormonal substitution with hGH, L-thyroxine, hydrocortisone, and estrogens led to normal physiological development and final height within upper target height. The reported case illustrates that the diagnosis of craniopharyngioma is often delayed due to unspecific clinical symptoms. Careful evaluation of anthropometrics, ophthalmologic, and endocrine data in patients with suspected eating disorders may give additional clues to the diagnosis of a craniopharyngioma.

Recurrent lymphocytic hypophysitis and bilateral intracavernous carotid artery occlusion. An observation and review of the literature

Objectives: Bilateral carotid artery occlusion associated with lymphocytic hypophysitis is exceedingly rare. We describe this association and review the literature.Methods: The authors describe a 38-year-old woman with a history of severe headaches. Magnetic resonance (MR) imaging showed an intrasellar mass with invasion of both cavernous sinuses. Lymphocytic hypophysitis was diagnosed by transphenoidal biopsy. In the course of the disease, she developed symptoms of cerebral ischemia attributable to bilateral occlusion of her internal carotid arteries in both cavernous sinuses. She underwent bilateral superficial temporal artery-middle cerebral artery bypass surgery.Results: The patient experienced progressive neurological recovery after surgery. A literature search revealed no other cases describing this unique association.Conclusions: Bilateral carotid artery occlusion may develop in the course of lymphocytic hypophysitis with cavernous sinus involvement. If indicated, cerebral revascularization should be performed to reverse cerebral ischemia.

Intrasellar plasmacytoma presenting as a non-functional invasive pituitary macro-adenoma: Case Report & Literature Review

We report an uncommon case of an intrasellar plasmacytoma presenting as a non-functional invasive pituitary macro-adenoma as the first manifestation of multiple myeloma. A 57 year old woman was referred to our department with a presumed diagnosis of a non-functioning pituitary macro-adenoma. She reported a 3 month history of headaches and a 2 week history of sudden onset of right facial numbness. Preoperative endocrine evaluation was remarkable only for a modestly elevated serum prolactin. A magnetic resonance imaging (MRI) scan revealed 3.6 x 5 x 4 cm enhancing homogeneous intrasellar mass with extension into the sphenoid and cavernous sinuses bilaterally; the optic chiasm was not displaced. She underwent transphenoidal surgery of the sellar lesion. The surgical specimen was heavily infiltrated with abnormal plasma cells, which stained almost exclusively for Kappa light chain immunoglobulins. An extensive investigation was undertaken to look for occult myelomatous disease. A diagnosis of multiple myeloma was made 1 month later based on a combination of clinical, pathological and radiologic features. She underwent radiation therapy directed towards the residual sellar tumor, followed by chemotherapy and autologous stem cell transplantation. Review of the world literature revealed only 22 previous reports of patients in whom a solitary plasmacytoma or multiple myeloma first presented as a sellar mass; in all cases mimicking clinically and radiologically a non-functioning invasive pituitary adenoma however with additional cranial nerve involvement. Intrasellar plasma cell tumors are rare tumors which may mimic non-functioning invasive pituitary tumors. The diagnosis should be suspected in patients with well preserved anterior pituitary function and cranial nerve neuropathies in the presence of significant sellar destruction.

An intrasellar germinoma with normal cerebrospinal fluid ?-HCG concentrations misdiagnosed as hypophysitis

A patient with an intrasellar germinoma leading to pituitary stalk thickening is reported. The patient, a 24-year old woman, presented with hyperprolactinemia, secondary hypothyroidism, and hypogonadotropic hypogonadism with no evidence of diabetes insipidus. Cerebrospinal fluid (CSF) examination revealed an increased number of lymphocytes and histiocytes. Although beta-HCG concentration was normal (<2 mIU/mL) in the CSF, increased beta-HCG concentration was detected in the serum. Systemic glucocorticoid treatment led to a decrease in CSF cell count, but no regression of the sellar mass was noted. A diagnostic biopsy was performed and showed an intrasellar germinoma. The patient underwent conventional radiotherapy. Complete resolution of the mass lesion and normalization of beta-HCG concentration in the serum were observed three months after radiotherapy. The presence of intrasellar mass lesion in association with pituitary stalk thickening may cause difficulties in the differential diagnosis. Histopathological examination is essential in equivocal cases in order to reach accurate diagnosis and apply the most appropriate therapy.

Intrasellar Remote Metastasis from Adenoid Cystic Carcinoma of Parotid Gland: Case Report

Adenoid cystic carcinoma is a tumor of exocrine glands originating primarily from the minor and major salivary glands, lacrimal gland, bronchus, breast, and intestinal and genital tracts. Intracranial remote metastasis from adenoid cystic carcinoma in salivary gland is quite rare. The authors encountered a case of intrasellar remote metastasis from an adenoid cystic carcinoma of parotid gland origin, presenting with hyponatremia secondary to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). To our knowledge, this is the first reported case of metastasis from an adenoid cystic carcinoma to intrasellar area. A 78-year-old woman had an adenoid cystic carcinoma in the left parotid gland, which was resected surgically followed by local radiation therapy of 60 Gy. After 4 years, the patient presented with general malaise, followed by disturbed consciousness caused by hyponatremia. The clinical data showed severe hyponatremia induced by SIADH. An intrasellar heterogenous mass lesion compressing the optic chiasm was resected subtotally via an endonasal transsphenoidal approach. Histopathological examination of the tumor specimens revealed adenoid cystic carcinoma, which had identical histological findings as those of the painful superficial cervical lymph nodes resected in the same operation. Tumors such as the present case are easily confused with pituitary adenoma or craniopharyngioma. Although rare, metastasis from tumors including those of salivary gland origin should be considered in the differential diagnosis of unusual pituitary tumors.

Perioperative Management of Patients Undergoing Transsphenoidal Pituitary Surgery

Pituitary adenomas often present with the symptoms of hormonal hypersecretion, and although medical therapy is available for most hyperfunctioning states, it is not curative. As a result, transsphenoidal pituitary surgery has become a commonly performed neurosurgical procedure with unique challenges for the anesthesiologist due to the distinct medical comorbidities associated with various adenomas. Any type of pituitary tumor may also produce hypopituitarism and local mass effects secondary to the expanding intrasellar mass. Here we review the perioperative concerns surrounding surgery to remove adenomas and decompress the sellar space. Special attention is given to Cushing's disease (hypercortisolism secondary to an adrenocorticotropic hormone-secreting adenoma), acromegaly (secondary to a growth hormone-secreting adenoma), and hyperthyroidism in the setting of thyrotropic adenomas. Operative risks, including bleeding, diabetes insipidus, the syndrome of inappropriate antidiuretic hormone secretion, and hypopituitarism, are addressed in detail. Understanding preoperative assessment, intraoperative management, potential complications, their management, and strategies for avoidance are fundamental to successful perioperative patient care and avoidance of morbidity and mortality.

Primary Intracranial Melanocytic Tumor Simulating Pituitary Macroadenoma: Case Report and Review of the Literature

Primary intracranial melanocytic tumors are rare lesions, sellar ones being even more exceptional. So far, six melanomas and two melanocytomas have been described in an intrasellar and/or suprasellar location. We report on the case of a 25-year-old Caucasian woman presenting with a 4-year history of amenorrhea and an intrasellar mass with suprasellar extension suggestive of a pituitary macroadenoma. A gross subtotal resection of a hemorrhagic tumor was performed. Histological examination revealed melanin-laden pleomorphic tumor cells that tested positive for HMB-45 and S-100 and negative for cytokeratins, thus demonstrating that the tumor was a melanocytic neoplasm. An extensive workup failed to find evidence of any other primary site. The patient received no further treatment and is alive and well after 24 months of follow-up. Primary sellar melanocytic neoplasms are extremely rare lesions and present with few differential diagnoses. Deciding whether the tumor is best classified as a melanocytoma or a melanoma may prove difficult. Wide histological variations in both melanocytomas and melanomas render careful consideration of the clinical, radiological, and gross features essential in distinguishing one from the other.

Recurrent glomus tumor of the sellar region with malignant progression

Glomus tumors are small, benign mesenchymal neoplasms, the majority of which occur in the dermis or subcutis of the extremities. The single most common site is the subungual region of the fingers, followed by palm, wrist, forearm and foot. The tumor cells resemble modified smooth muscle cells of normal glomus bodies. Glomus tumors, however, have been reported in locations in which the glomus bodies are sparse or even absent, among them patella, nerve, eyelid, liver, gastrointestinal tract, trachea, nose, bone and sella turcica [3, 9]. Glomus tumors usually show a benign clinical course. However, rare malignant cases have been reported [5, 6, 7]. In a recent review on atypical and malignant glomus tumors, Folpe et al. [3] have proposed a classification scheme, encompassing malignant glomus tumors, symplastic glomus tumors, glomus tumors of uncertain malignant potential and glomangiomatosis. Glomus tumors in the sellar region are exceedingly rare and to the best of our knowledge only one case has been reported so far in this location [2]. Here we report the case of an intraand parasellar neoplasm first diagnosed as a benign glomus tumor. Recurrent tumor growth was observed 8 and 10 years after the first surgical intervention and subsequent histology suggested malignant progression of the glomus tumor. In 1991, 9 months after a moderate cervical spine trauma, the 47-year-old female patient noted intermittent diplopia. Ophthalmological examination revealed a right-sided cavernous sinus syndrome with palsy of the occulomotor, trochlear and abducent nerves. Cranial computer tomography and magnetic resonance imaging (MRI) showed an intrasellar mass lesion that extended into the right-sided supraand parasellar regions including the cavernous sinus. Microsurgical tumor resection was performed with a right pterional craniotomy approach. The residual tumor was treated by fractioned radiation therapy (27 fractions with a total dose of 54 Gy). Apart from a persisting right-sided trochlear nerve palsy the clinical history was uneventful till May 1999, when the patient developed a right-sided lid ptosis and an intermittent diplopia. On MRI scans, the tumor was found to have recurred and expanded to the right supraand parasellar regions, now measuring 3 cm in diameter (Fig. 1A). Incomplete tumor resection was performed via a transsphenoidal approach followed by gamma knife radiosurgery with a total dose of 25 Gy. In July 2001 the patient noted further visual impairment and ophthalmological testing revealed loss of visual acuity and visual field defects in the right eye. Endocrinological examination demonstrated panhypopituitarism. Repeated MRI scans again showed tumor growth in the right supraand parasellar region measuring up to 3.5 cm in diameter. The patient underwent right-sided pterional recraniotomy with incomplete tumor resection. Due to progressive visual impairment a further transsphenoidal tumor resection was undertaken in November 2001. Further radiation therapy was initially refused; however, due to progressive tumor growth (Fig. 1B) a targeted radiotherapy using Yttrium-DOTATOC, an Yttrium-labeled somatostatin analogue, was conducted early in 2003. The patient died in October 2003, 12 years after initial manifestation of the tumor. No autopsy was performed. D. Hanggi Department of Neurosurgery, University Hospital Dusseldorf, Dusseldorf, Germany

Giant Intrasellar Arachnoid Cyst Manifesting as Adrenal Insufficiency Due to Hypothalamic Dysfunction-Case Report-

A 67-year-old man first noticed loss of pubic and axillary hair in 1992 and then a visual field defect in 2001. He experienced loss of consciousness attributed to hyponatremia in April 2002. Magnetic resonance imaging showed a giant intrasellar cystic mass, 40 mm in diameter, that had compressed the optic chiasm. The patient complained of chronic headache, and neurological examination revealed bitemporal hemianopsia. Preoperative endocrinological examination indicated adrenal insufficiency, and hypothyroidism due to hypothalamic dysfunction. The patient underwent endonasal transsphenoidal surgery. The cyst membrane was opened and serous fluid was drained. Histological examination identified the excised cyst membrane as arachnoid membrane. The patient's headaches resolved postoperatively, but the bitemporal hemianopsia and endocrinological function were unchanged. This arachnoid cyst associated with hypothalamic dysfunction might have been caused by an inflammatory episode in the suprasellar region.

Effect of treatment with pegvisomant on meningioma growth in vivo

Pegvisomant is a pegylated analogue of human growth hormone (GH) that functions as a GH receptor antagonist. Although its use is currently limited to patients with acromegaly (1), there exists considerable interest in the potential use of pegvisomant for the treatment of a variety of tumours whose growth may be promoted by insulin-like growth factor-I (IGF-I). We report the case of a 74-year-old woman with acromegaly, treated with pegvisomant, in whom we have documented the growth rate of a meningioma noted incidentally during the course of routine radiological imaging. The patient’s acromegaly was diagnosed in 1992 on the basis of failure of suppression of serum GH during a 75 g oral glucose load (nadir serum GH 10 mU/l) and an elevated serum IGF-I concentration (489 ng/ml, age-adjusted normal range 109 –269). Magnetic resonance imaging (MRI) of the pituitary demonstrated a 9 mm intrasellar pituitary mass lesion. She declined surgical adenomectomy or pituitary irradiation and was successfully treated with thrice-daily s.c. octreotide (serum IGF-I within ageadjusted normal range). In 1998, she enrolled in a 12 week placebo-controlled study of pegvisomant in the treatment of acromegaly (2) and was randomised to receive pegvisomant 10 mg daily. At its conclusion, she continued pegvisomant in an open-label study, but therapy was suspended after 9 months because of a shortage of drug. Eight weeks after cessation of pegvisomant, depot octreotide 10 mg four-weekly was commenced and continued for 26 months. In December 2001, she enrolled in an open-label study of patients with acromegaly converting from stable treatment with depot octreotide to therapy with pegvisomant and continued this drug at a dose of 10 mg daily until May 2004. Regular surveillance pituitary imaging was performed during both clinical trials. Incidental note was made, at the start of the first trial, of a dural-based homogeneously enhancing mass related to the greater wing of the sphenoid, typical of a meningioma (Fig. 1A). She reported no symptoms referable to the mass and declined any surgical intervention. Axial, sagittal and coronal dimensions of the mass were recorded at each scan and the volume calculated, for a prolate ellipsoid, using the formula 4/3p(height/2) (width/2)(depth/2) (3). The volume of the meningioma increased from 470 to 4810 mm 5 years later (Fig. 1B), with no discernible inhibitory effect of pegvisomant therapy (Fig. 2). Pegvisomant inhibits the functional dimerisation of cell surface GH receptors, thereby reducing IGF-I

Metastatic Renal Cell Carcinoma Mimicking Pituitary Adenoma-Case Report-

A 54-year-old man, with a past history of renal cell carcinoma, presented with bitemporal visual field defect, hyponatremia, and diabetes insipidus. Endocrinological examination revealed panhypopituitarism. Computed tomography and magnetic resonance imaging showed an intrasellar mass with suprasellar extension. The initial radiological impression was pituitary adenoma. The tumor was decompressed via the transsphenoidal route. Histological examination revealed metastatic renal cell carcinoma. The clinical characteristics of metastatic pituitary carcinoma appear to be panhypopituitarism, and neuroimaging findings of strong enhancement of the tumor and bony destruction without marked sellar enlargement.

Magnetic resonance imaging of pituitary adenomas

Today, MR is the only method needed for the morphological investigation of endocrine-active pituitary adenomas. In acromegaly and Cushing's syndrome, the therapeutic attitude is directly dictated by MR data. We present the MR aspect of pituitary adenomas according to size, sex, age, endocrine activity and a few particular conditions such as hemorrhagic pituitary adenomas, pituitary adenomas during pregnancy, cavernous sinus invasion and postsurgical changes. When an intrasellar mass extending out of the sella turcica is detected, the goal of the MR examination is to indicate precisely the origin of the tumor, its extension in relation to the various surrounding structures, its structure and its enhancement in order to help in the differential diagnosis. Demonstration of very small pituitary adenomas remains a challenge. When SE T1- and Turbo SE T2-weighted sequences are non-diagnostic, enhanced imaging becomes mandatory; half-dose gadolinium injection, delayed sequence, dynamic imaging can be of some help.

Anterior communicating artery aneurysm in the sella turcica: case report

Background Only 3 such reported intrasellar aneurysms have arisen from the anterior communicating artery. Case description A neurologically normal 38-year-old man complaining of headache underwent cranial magnetic resonance imaging, which showed a heterogeneously enhancing, partially calcified intrasellar mass. The normal pituitary gland was identified at the bottom of the sella, and the optic chiasm was located superior to the aneurysm. Digital subtraction angiography and three-dimensional computed tomography angiography demonstrated the mass to be a partially thrombosed anterior communicating artery aneurysm. Frontotemporal craniotomy was performed, but initial attempts to occlude the neck of the aneurysm were unsuccessful. We could not expose the dome of the aneurysm or confirm the anatomic relationship of the pituitary to the aneurysm. The patient declined further intervention, and close follow-up has been maintained. Conclusion Our case suggested that unlike intrasellar aneurysms arising from the internal carotid artery, intrasellar aneurysms originating from the anterior communicating artery are likely to present difficulty in dissecting the neck of the aneurysm from the bilateral optic nerves and pituitary stalk, impeding direct aneurysm clipping. When we operated upon a patient with a large unruptured intrasellar aneurysm originating from the anterior communicating artery via the prechiasmatic space, we encountered considerable technical difficulty.

Hipotireoidismo primário simulando volumoso macroadenoma hipofisário

A 21-year-old woman complaining of 8-month amenorrhea associated to weight gain, galactorrhea and frequent headaches, presented for clinical evaluation; her laboratory tests were: TSH: 1192 mUI/ml (0.27-4.2); TT4: 1.0 microg/dl (4.4-11.4 l); TT3: 0.41 ng/ml (0.7-2.1); prolactin: 69.2 ng/ml (3-20) and a diagnosis of myxedema associated to galactorrhea was made. A hypothalamic-pituitary magnetic resonance imaging (MRI) showed a suprasellar and intrasellar mass lesion of 1.9 x 1.4 x 1.9 cm, determining compression and deviation of the optic chiasm. Due to the possibility of hyperplasia of the TSH-producing cells, treatment of hypothyroidism was initiated with levothyroxine. Two months later, upon normalization of thyroid hormones and TSH levels, a second MRI showed an anatomically normal pituitary gland. Regression of the pituitary mass after treatment with levothyroxine confirmed the hypothesis of pituitary hyperplasia secondary to primary hypothyroidism. Our findings support the importance of determining thyroid function tests during the investigation of pituitary masses and thus avoiding an unnecessary surgery.

Rare case of metastatic prostate adenocarcinoma to the pituitary

We report a rare case of metastatic prostate adenocarcinoma to the pituitary gland. The patient had lung and bone metastases when he presented with bitemporal hemianopsia. He was also receiving total androgen blockade at that time. Magnetic resonance imaging showed an intrasellar mass, and biopsy confirmed metastatic prostate cancer. Radiotherapy, in the form of intensity-modulated radiotherapy, was delivered to the intrasellar mass. The patient responded well to radiotherapy. The mechanisms of spread to the pituitary gland and treatment options, including intensity-modulated radiotherapy, are discussed.

A Case of Anterior Hypopituitarism Showing Recurrent Pituitary Mass Associated with Central Diabetes Insipidus

We report a case of anterior hypopituitarism showing recurrent pituitary mass associated with central diabetes insipidus. A 76-year old woman was hospitalized with general fatigue and 5 kg body weight loss. Endocrinological examinations and pituitary provocative tests demonstrated hypopituitarism and central diabetes insipidus. T1-weighted image of magnetic resonance imaging (MRI) revealed an intrasellar cystic mass with ring enhancement suggesting pituitary abscess. MRI films subsequently obtained from another hospital and studied retrospectively showed intrasellar cystic mass with ring enhancement 4 years earlier, and a mass shape that was decreased after 2 years. Over the subsequent years, the patient has remained asymptomatic with hormone replacement therapy only. Cystic pituitary adenoma or Rathke's cleft cyst with repeated infection may be involved in the repeated change of pituitary mass shape although neither pituitary surgery nor a pituitary biopsy was performed because of the patient's age and condition. It is reported that apparent recurrence of Rathke's cleft cysts after initially successful surgery was higher than suggested by previous reports, and that long-term follow-up with pituitary imaging and neuroophthalmological assessment is essential. Careful evaluation by follow-up brain MRI is needed in the present case to prevent future recurrence of pituitary abscess.

Metastases to the Pituitary Gland

Pituitary metastasis is a rare cause of an intrasellar mass. The authors report a series of 52 patients with intrasellar metastases diagnosed between 1950 and 1996. The patient group included 29 women and 23 men with a mean age of 60 years. Breast and lung carcinomas were the most frequent primary tumors (37% and 23%, respectively). The primary tumor was unknown in 12% of patients. In the patients with a known primary tumor, it was diagnosed after the pituitary metastasis was discovered in 20%. The mode of discovery of pituitary metastases was symptom-based (visual impairment, diabetes insipidus, hypopituitarism) in 75% of patients. Of the patients in whom prolactin was measured, 63% had hyperprolactinemia. Computed tomography and magnetic resonance imaging of the brain, available for 52% and 19% of patients, respectively, showed a pituitary mass in each case. Pituitary surgery and radiotherapy were performed in 42% and 63% of patients, respectively. Mean survival was 17 months (range, 0–240 months). Overall mortality at 1 year was 67%.