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Evaluation of Sellar Masses

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Endocrinology and Diabetes

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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.

In this chapter the clinical, radiologic, and laboratory evaluation of patients with a sellar mass will be discussed. As over 94 % of sellar masses are either pituitary adenomas or Rathke’s cleft cysts (Freda and Post, Endocrinol Metab Clin North Am 28:81–117, 1999), management of these lesions will be emphasized. A limited discussion of the less common lesions are included emphasizing those characteristics that help differentiate them from adenomas and Rathke’s cleft cysts.

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Authors and Affiliations

  1. Endocrinology, Diabetes and Nutrition, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Todd B. Nippoldt M.D.

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  1. Todd B. Nippoldt M.D.
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Correspondence to Todd B. Nippoldt M.D. .

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Editors and Affiliations

  1. Professor Associado e Livre-Docente, Disciplina de Endocrinologia da Faculdade de Ciências Medicas da Universidade de Pernambuco, Chefe da Divisão de Endocrinologia e Diabetes do Hospital Agamenon, Magalhães-MS/UPE, Recife, Brazil

    Francisco Bandeira

  2. American Thyroid Association Past President, American Association of Clinical Endocrinologists, Professor of Medicine, Mayo Clinic College of Medicine President-Elect, Rochester, Minnesota, USA

    Hossein Gharib

  3. Federal Foundation and School of Medical Sciences, Porto Alegre, Brazil

    Airton Golbert

  4. Department of Medicine, University of Pernambuco School of Medicine, Recife, Brazil

    Luiz Griz

  5. Department of Medicine, University of Maranhao School of Medicine, Sao Luis, Brazil

    Manuel Faria

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Nippoldt, T.B. (2014). Evaluation of Sellar Masses. In: Bandeira, F., Gharib, H., Golbert, A., Griz, L., Faria, M. (eds) Endocrinology and Diabetes. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8684-8_5

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