Causes, presentation, and evaluation of sellar masses
- Peter J Snyder, MD
Peter J Snyder, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Pituitary Disease; Male Reproductive Endocrinology
- Professor of Medicine
- University of Pennsylvania School of Medicine
Sellar masses typically present in one or more ways:
●With neurologic symptoms, such as visual impairment or headache
●As an incidental finding on magnetic resonance imaging (MRI) performed for some other reason
●With hormonal abnormalities
This topic will review the causes, clinical manifestations, and evaluation of sellar masses. The clinical presentation and management of individual pituitary tumors and of hypopituitarism are discussed separately. (See "Clinical manifestations and evaluation of hyperprolactinemia" and "Clinical manifestations and diagnosis of gonadotroph and other clinically nonfunctioning pituitary adenomas" and "Clinical manifestations of hypopituitarism" and "Diagnostic testing for hypopituitarism".)
- Gsponer J, De Tribolet N, Déruaz JP, et al. Diagnosis, treatment, and outcome of pituitary tumors and other abnormal intrasellar masses. Retrospective analysis of 353 patients. Medicine (Baltimore) 1999; 78:236.
- Freda PU, Post KD. Differential diagnosis of sellar masses. Endocrinol Metab Clin North Am 1999; 28:81.
- Saeger W, Lüdecke DK, Buchfelder M, et al. Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary Tumor Registry. Eur J Endocrinol 2007; 156:203.
- Alexander JM, Biller BM, Bikkal H, et al. Clinically nonfunctioning pituitary tumors are monoclonal in origin. J Clin Invest 1990; 86:336.
- Herman V, Fagin J, Gonsky R, et al. Clonal origin of pituitary adenomas. J Clin Endocrinol Metab 1990; 71:1427.
- Raappana A, Koivukangas J, Ebeling T, Pirilä T. Incidence of pituitary adenomas in Northern Finland in 1992-2007. J Clin Endocrinol Metab 2010; 95:4268.
- Fernandez A, Karavitaki N, Wass JA. Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol (Oxf) 2010; 72:377.
- Bassett JH, Forbes SA, Pannett AA, et al. Characterization of mutations in patients with multiple endocrine neoplasia type 1. Am J Hum Genet 1998; 62:232.
- Crabtree JS, Scacheri PC, Ward JM, et al. A mouse model of multiple endocrine neoplasia, type 1, develops multiple endocrine tumors. Proc Natl Acad Sci U S A 2001; 98:1118.
- Landis CA, Masters SB, Spada A, et al. GTPase inhibiting mutations activate the alpha chain of Gs and stimulate adenylyl cyclase in human pituitary tumours. Nature 1989; 340:692.
- Vallar L, Spada A, Giannattasio G. Altered Gs and adenylate cyclase activity in human GH-secreting pituitary adenomas. Nature 1987; 330:566.
- Zhang X, Horwitz GA, Heaney AP, et al. Pituitary tumor transforming gene (PTTG) expression in pituitary adenomas. J Clin Endocrinol Metab 1999; 84:761.
- Vlotides G, Eigler T, Melmed S. Pituitary tumor-transforming gene: physiology and implications for tumorigenesis. Endocr Rev 2007; 28:165.
- Ezzat S, Zheng L, Zhu XF, et al. Targeted expression of a human pituitary tumor-derived isoform of FGF receptor-4 recapitulates pituitary tumorigenesis. J Clin Invest 2002; 109:69.
- Snyder PJ. Gonadotroph adenomas. In: Endocrinology, DeGroot LJ (Ed), WB Saunders, Philadelphia 2001.
- Bassetti M, Spada A, Arosio M, et al. Morphological studies on mixed growth hormone (GH)- and prolactin (PRL)-secreting human pituitary adenomas. Coexistence of GH and PRL in the same secretory granule. J Clin Endocrinol Metab 1986; 62:1093.
- Shimono T, Hatabu H, Kasagi K, et al. Rapid progression of pituitary hyperplasia in humans with primary hypothyroidism: demonstration with MR imaging. Radiology 1999; 213:383.
- Alkhani AM, Cusimano M, Kovacs K, et al. Cytology of pituitary thyrotroph hyperplasia in protracted primary hypothyroidism. Pituitary 1999; 1:291.
- Groff TR, Shulkin BL, Utiger RD, Talbert LM. Amenorrhea-galactorrhea, hyperprolactinemia, and suprasellar pituitary enlargement as presenting features of primary hypothyroidism. Obstet Gynecol 1984; 63:86S.
- Samaan NA, Stepanas AV, Danziger J, Trujillo J. Reactive pituitary abnormalities in patients with Klinefelter's and Turner's syndromes. Arch Intern Med 1979; 139:198.
- Scheithauer BW, Moschopulos M, Kovacs K, et al. The pituitary in klinefelter syndrome. Endocr Pathol 2005; 16:133.
- Ezzat S, Asa SL, Stefaneanu L, et al. Somatotroph hyperplasia without pituitary adenoma associated with a long standing growth hormone-releasing hormone-producing bronchial carcinoid. J Clin Endocrinol Metab 1994; 78:555.
- Ragel BT, Couldwell WT. Pituitary carcinoma: a review of the literature. Neurosurg Focus 2004; 16:E7.
- Giustina A, Gola M, Doga M, Rosei EA. Clinical review 136: Primary lymphoma of the pituitary: an emerging clinical entity. J Clin Endocrinol Metab 2001; 86:4567.
- Fassett DR, Couldwell WT. Metastases to the pituitary gland. Neurosurg Focus 2004; 16:E8.
- Schubiger O, Haller D. Metastases to the pituitary--hypothalamic axis. An MR study of 7 symptomatic patients. Neuroradiology 1992; 34:131.
- Morita A, Meyer FB, Laws ER Jr. Symptomatic pituitary metastases. J Neurosurg 1998; 89:69.
- Trifanescu R, Ansorge O, Wass JA, et al. Rathke's cleft cysts. Clin Endocrinol (Oxf) 2012; 76:151.
- Culver SA, Grober Y, Ornan DA, et al. A Case for Conservative Management: Characterizing the Natural History of Radiographically Diagnosed Rathke Cleft Cysts. J Clin Endocrinol Metab 2015; 100:3943.
- Al-Holou WN, Terman S, Kilburg C, et al. Prevalence and natural history of arachnoid cysts in adults. J Neurosurg 2013; 118:222.
- Vates GE, Berger MS, Wilson CB. Diagnosis and management of pituitary abscess: a review of twenty-four cases. J Neurosurg 2001; 95:233.
- Sato N, Putman CM, Chaloupka JC, et al. Pituitary gland enlargement secondary to dural arteriovenous fistula in the cavernous sinus: appearance at MR imaging. Radiology 1997; 203:263.
- Thodou E, Asa SL, Kontogeorgos G, et al. Clinical case seminar: lymphocytic hypophysitis: clinicopathological findings. J Clin Endocrinol Metab 1995; 80:2302.
- Dillard T, Yedinak CG, Alumkal J, Fleseriu M. Anti-CTLA-4 antibody therapy associated autoimmune hypophysitis: serious immune related adverse events across a spectrum of cancer subtypes. Pituitary 2010; 13:29.
- Yang JC, Hughes M, Kammula U, et al. Ipilimumab (anti-CTLA4 antibody) causes regression of metastatic renal cell cancer associated with enteritis and hypophysitis. J Immunother 2007; 30:825.
- Ribas A, Comin-Anduix B, Chmielowski B, et al. Dendritic cell vaccination combined with CTLA4 blockade in patients with metastatic melanoma. Clin Cancer Res 2009; 15:6267.
- Snyder PJ. Gonadotroph adenomas. In: The Pituitary, 2nd, Melmed S (Ed), Blackwell Science Inc., Malden, MA 2002. p.575.
- Pressman BD. Pituitary imaging. In: The Pituitary, 2nd, Melmed S (Ed), Blackwell Science Inc., Malden, MA 2002. p.663.
- Taylor SL, Barakos JA, Harsh GR 4th, Wilson CB. Magnetic resonance imaging of tuberculum sellae meningiomas: preventing preoperative misdiagnosis as pituitary macroadenoma. Neurosurgery 1992; 31:621.
- King JT Jr, Justice AC, Aron DC. Management of incidental pituitary microadenomas: a cost-effectiveness analysis. J Clin Endocrinol Metab 1997; 82:3625.
- Pituitary adenomas
- - Incidence and prevalence
- - Genetics
- - Classification
- Pituitary hyperplasia
- Other benign tumors
- - Craniopharyngioma
- - Meningioma
- - Pituicytoma
- Malignant tumors
- - Primary
- - Metastatic disease
- Arteriovenous fistula of the cavernous sinus
- CLINICAL MANIFESTATIONS
- Visual defects
- Other neurologic symptoms
- Hormone deficiencies
- EVALUATION OF A SELLAR MASS
- Radiologic procedures
- - MRI
- Unenhanced image
- Gadolinium-enhanced image
- - CT scan
- Hormonal evaluation
- - Hormonal hypersecretion
- - Hormonal hyposecretion
- Pituitary incidentaloma
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS