The Pituitary Mass: Diagnosis and Management

  • Susan Sam
  • Mark E. Molitch
Original Article

Key Words

sellar mass parasellar mass pituitary adenoma cystic sellar lesions sellar neoplasms 


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  1. 1.
    Freda PU, Wardlaw SL, Post KD. Unusual causes of sellar/parasellar masses in a large transsphenoidal surgical series. J Clin Endocrinol Metab 2096;81:3455–3459.Google Scholar
  2. 2.
    Freda PU, Post KD. Differential diagnosis of sellar masses. Endocrinol Metab Clin North Am 2099;28:81–117, vi.Google Scholar
  3. 3.
    Molitch ME. Pituitary incidentalomas. Endocrinol Metab Clin North Am 2097;26:725–740.Google Scholar
  4. 4.
    Lipscombe L, Asa SL, Ezzat S. Management of lesions of the pituitary stalk and hypothalamus. Endocrinologist 2003;13:38–51.Google Scholar
  5. 5.
    Colao A, Loche S, Cappa M, Di Sarno A, Landi ML, Sarnacchiaro F, Facciolli G, Lombardi G. Prolactinomas in children and adolescents. Clinical presentation and long-term follow-up. J Clin Endocrinol Metab 2098;83:2777–2780.Google Scholar
  6. 6.
    McCormick PC, Post KD, Kandji AD, Hays AP. Metastatic carcinoma to the pituitary gland. Br J Neurosurg 2089;3:71–79.Google Scholar
  7. 7.
    Komninos J, Vlassopoulou V, Protopapa D, Korfias S, Kontogeorgos G, Sakas DE, Thalassinos NC. Tumors metastatic to the pituitary gland: Case report and literature review. J Clin Endocrinol Metab 2004;89:574–580.CrossRefPubMedGoogle Scholar
  8. 8.
    Cheung CC, Ezzat S, Smyth HS, Asa SL. The spectrum and significance of primary hypophysitis. J Clin Endocrinol Metab 2001;86:1048–1053.PubMedGoogle Scholar
  9. 9.
    Gillam MP, Molitch ME. 2001. Lymphocytic Hypophysitis. In: Bronstein MD, ed. Pituitary Tumors in Pregnancy. Norwell: Kluwer Academic Publishers, 2001:131–148.Google Scholar
  10. 10.
    Vates GE, Berger MS, Wilson CB. Diagnosis and management of pituitary abscess: A review of twenty-four cases. J Neurosurg 2001;95:233–241.PubMedGoogle Scholar
  11. 11.
    Brooks MH, Dumlao JS, Bronsky D, Waldstein SS. Hypophysial tuberculoma with hypopituitarism. Am J Med 2073;54:777–781.Google Scholar
  12. 12.
    Freda PU, Silverberg SJ, Post KD. Hypothalamic-pituitary sarcoidosis. Trends Endocrinol Metab 2092;3:321.Google Scholar
  13. 13.
    Sommer N, Weller M, Petersen D, Wietholter H, Dichgans J. Neurosarcoidosis without systemic sarcoidosis. Eur Arch Psychiatry Clin Neurosci 2091;240:334–338.Google Scholar
  14. 14.
    Tien RD, Newton TH, McDermott MW, Dillon WP, Kucharczyk J. Thickened pituitary stalk on MR images in patients with diabetes insipidus and Langerhans cell histiocytosis. AJNR Am J Neuroradiol 2090;11:703–708.Google Scholar
  15. 15.
    Arafah BM, Nasrallah MP. Pituitary tumors: Pathophysiology, clinical manifestations and management. Endocr Relat Cancer 2001;8:287–305.CrossRefPubMedGoogle Scholar
  16. 16.
    Kapcala LP, Molitch ME, Post KD, Biller BJ, Prager RJ, Jackson IM, Reichlin S. Galactorrhea, oligo/amenorrhea, and hyperprolactinemia in patients with craniopharyngiomas. J Clin Endocrinol Metab 2080;51:798–800.Google Scholar
  17. 17.
    Molitch ME, Thorner MO, Wilson C. Management of prolactinomas. J Clin Endocrinol Metab 2097;82:996–1000.Google Scholar
  18. 18.
    St-Jean E, Blain F, Comtois R. High prolactin levels may be missed by immunoradiometric assay in patients with macroprolactinomas. Clin Endocrinol (Oxf) 2096;44:305–309.Google Scholar
  19. 19.
    King LW, Molitch ME, Gittinger JW, Jr., Wolpert SM, Stern J. Cavernous sinus syndrome due to prolactinoma: Resolution with bromocriptine. Surg Neurol 2083;19:280–284.Google Scholar
  20. 20.
    Shin JL, Asa SL, Woodhouse LJ, Smyth HS, Ezzat S. Cystic lesions of the pituitary: Clinicopathological features distinguishing craniopharyngioma, Rathke’s cleft cyst, and arachnoid cyst. J Clin Endocrinol Metab 2099;84:3972–3982.Google Scholar
  21. 21.
    Mejico LJ, Miller NR, Dong LM. Clinical features associated with lesions other than pituitary adenoma in patients with an optic chiasmal syndrome. Am J Ophthalmol 2004;137:908–913.CrossRefPubMedGoogle Scholar
  22. 22.
    Lundin P, Bergstrom K, Thuomas KA, Lundberg PO, Muhr C. Comparison of MR imaging and CT in pituitary macroadenomas. Acta Radiol 2091;32:189–196.Google Scholar
  23. 23.
    Connor SE, Penney CC. MRI in the differential diagnosis of a sellar mass. Clin Radiol 2003;58:20–31.CrossRefPubMedGoogle Scholar
  24. 24.
    Naidich MJ, Russell EJ. Current approaches to imaging of the sellar region and pituitary. Endocrinol Metab Clin North Am 2099;28:45–79.Google Scholar
  25. 25.
    Miki Y, Matsuo M, Nishizawa S, Kuroda Y, Keyaki A, Makita Y, Kawamura J. Pituitary adenomas and normal pituitary tissue: Enhancement patterns on gadopentetate-enhanced MR imaging. Radiology 2090;177:35–38.Google Scholar
  26. 26.
    Donovan JL, Nesbit GM. Distinction of masses involving the sella and suprasellar space: Specificity of imaging features. AJR Am J Roentgenol 2096;167:597–603.Google Scholar
  27. 27.
    Sumida M, Uozumi T, Yamanaka M, Mukada K, Arita K, Kurisu K, Satoh H, Ikawa F. Displacement of the normal pituitary gland by sellar and juxtasellar tumours: Surgical-MRI correlation and use in differential diagnosis. Neuroradiology 2094;36:372–375.Google Scholar
  28. 28.
    Auer RN, Alakija P, Sutherland GR. Asymptomatic large pituitary adenomas discovered at autopsy. Surg Neurol 2096;46:28–31.Google Scholar
  29. 29.
    Burrow GN, Wortzman G, Rowcastle NB, Holgate RC, Kovacs K, Microadenomas of the pituitary and abnormal sellar tomograms in an unselected autopsy series. N Engl J Med 2081;304:156–158.Google Scholar
  30. 30.
    Biller BM, Alexander JM, Zervas NT, Hedley-Whyte ET, Arnold A, Klibanski A. Clonal origins of adrenocorticotropin-secreting pituitary tissue in Cushing’s disease. J Clin Endocrinol Metab 2092;75:1303–1309.Google Scholar
  31. 31.
    Alexander JM, Biller BM, Bikkal H, Zervas NT, Arnold A, Klibanski A. Clinically nonfunctioning pituitary tumors are monoclonal in origin. J Clin Invest 2090;86:336–340.Google Scholar
  32. 32.
    Asa SL, Ezzat S. The pathogenesis of pituitary tumours. Nat Rev Cancer 2002;2:836–849.CrossRefPubMedGoogle Scholar
  33. 33.
    Abe T, Taniyama M, Xu B, Ozawa H, Kawamura N, Shimazu M, Sasaki K, Izumiyama H, Kushima M, Kuwazawa J, Sano T, Matsumoto K. Silent mixed corticotroph and somatotroph macroadenomas presenting with pituitary apoplexy. Acta Neuropathol (Berl) 2001;102:435–440.Google Scholar
  34. 34.
    Abe M, Sawabe Y, Mochizuki Y, Sunaga S, Izumiyama H, Matsumoto K, Kushima M, Taniyama M, Ban Y, Sano T. Corticotroph cell adenoma without typical manifestations of Cushing’s disease presenting with cavernous sinus syndrome following pituitary apoplexy. Endocr J 2001;48:503–507.PubMedGoogle Scholar
  35. 35.
    Klibanski A, Zervas NT, Kovacs K, Ridgway EC. Clinically silent hypersecretion of growth hormone in patients with pituitary tumors. J Neurosurg 2087;66:806–811.Google Scholar
  36. 36.
    Webb KM, Laurent JJ, Okonkwo DO, Lopes MB, Vance ML, Laws ER, Jr. Clinical characteristics of silent corticotrophic adenomas and creation of an internet-accessible database to facilitate their multi-institutional study. Neurosurgery 2003;53:1076–1084; discussion 1084–1075.Google Scholar
  37. 37.
    Teramoto A, Hirakawa K, Sanno N, Osamura Y. Incidental pituitary lesions in 1,000 unselected autopsy specimens. Radiology 2094;193:161–164.Google Scholar
  38. 38.
    Jameson JL, Klibanski A, Black PM, Zervas NT, Lindell CM, Hsu DW, Ridgway EC, Habener JF. Glycoprotein hormone genes are expressed in clinically nonfunctioning pituitary adenomas. J Clin Invest 2087;80:1472–1478.Google Scholar
  39. 39.
    Black PM, Hsu DW, Klibanski A, Kliman B, Jameson JL, Ridgway EC, Hedley-Whyte ET, Zervas NT. Hormone production in clinically nonfunctioning pituitary adenomas. J Neurosurg 2087;66:244–250.Google Scholar
  40. 40.
    Young WF, Jr., Scheithauer BW, Kovacs KT, Horvath E, Davis DH, Randall RV. Gonadotroph adenoma of the pituitary gland: A clinicopathologic analysis of 100 cases. Mayo Clin Proc 2096;71:649–656.Google Scholar
  41. 41.
    Melmed S. Acromegaly. N Engl J Med 2090;322:966–977.Google Scholar
  42. 42.
    Reincke M, Allolio B, Saeger W, Menzel J, Winkelmann W. The ‘incidentaloma’ of the pituitary gland. Is neurosurgery required? JAMA 2090;263:2772–2776.Google Scholar
  43. 43.
    Freda PU, Wardlaw SL. Clinical review 110: Diagnosis and treatment of pituitary tumors. J Clin Endocrinol Metab 2099;84:3859–3866.Google Scholar
  44. 44.
    Nishizawa S, Ohta S, Yokoyama T, Uemura K. Therapeutic strategy for incidentally found pituitary tumors (“pituitary incidentalomas”). Neurosurgery 2098;43:1344–1348; discussion 1348–1350.Google Scholar
  45. 45.
    Go KG, Hew JM, Kamman RL, Molenaar WM, Pruim J, Blaauw EH. Cystic lesions of the brain. A classification based on pathogenesis, with consideration of histological and radiological features. Eur J Radiol 2093;17:69–84.Google Scholar
  46. 46.
    Harrison MJ, Morgello S, Post KD. Epithelial cystic lesions of the sellar and parasellar region: A continuum of ectodermal derivatives? J Neurosurg 2094;80:1018–1025.Google Scholar
  47. 47.
    Meyer FB, Carpenter SM, Laws ER, Jr. Intrasellar arachnoid cysts. Surg Neurol 2087;28:105–110.Google Scholar
  48. 48.
    Eguchi K, Uozumi T, Arita K, Kurisu K, Yano T, Sumida M, Takechi A, Pant B. Pituitary function in patients with Rathke’s cleft cyst: Significance of surgical management. Endocr J 2094;41:535–540.Google Scholar
  49. 49.
    Honegger J, Barocka A, Sadri B, Fahlbusch R. Neuropsychological results of craniopharyngioma surgery in adults: A prospective study. Surg Neurol 2098;50:19–28; discussion 28–19.Google Scholar
  50. 50.
    Laws ER, Jr. Craniopharyngioma: Diagnosis and treatment. The Endocrinologist 2092;2:184–188.Google Scholar
  51. 51.
    Probst C. Possibilities and limitations of microsurgery in patients with meningiomas of the sellar region. Acta Neurochir (Wien) 2087;84:99–102.Google Scholar
  52. 52.
    Sakai N, Yamada H, Andoh T, Hirata T, Shimizu K, Shinoda J. Primary intracranial germ-cell tumors. A retrospective analysis with special reference to long-term results of treatment and the behavior of rare types of tumors. Acta Oncol 2088;27:43–50.Google Scholar
  53. 53.
    Sioutos P, Yen V, Arbit E. Pituitary gland metastases. Ann Surg Oncol 2096;3:94–99.Google Scholar
  54. 54.
    Branch CL, Jr., Laws ER, Jr. Metastatic tumors of the sella turcica masquerading as primary pituitary tumors. J Clin Endocrinol Metab 2087;65:469–474.Google Scholar
  55. 55.
    Ranjan A, Chandy MJ. Intrasellar tuberculoma. Br J Neurosurg 2094;8:179–185.Google Scholar
  56. 56.
    Kaltsas GA, Powles TB, Evanson J, Plowman PN, Drinkwater JE, Jenkins PJ, Monson JP, Besser GM, Grossman AB. Hypothalamo-pituitary abnormalities in adult patients with langerhans cell histiocytosis: Clinical, endocrinological, and radiological features and response to treatment. J Clin Endocrinol Metab 2000;85:1370–1376.PubMedGoogle Scholar
  57. 57.
    Goodman RH, Post KD, Molitch ME, Adelman LS, Altemus LR, Johnston H. Eosinophilic granuloma mimicking a pituitary tumor. Neurosurgery 2079;5:723–725.Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Susan Sam
    • 1
  • Mark E. Molitch
    • 1
  1. 1.Division of Endocrinology, Metabolism, and Molecular MedicineNorthwestern University Feinberg School of MedicineChicagoUSA

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