Hypothalamic, Pituitary And Other Sellar Masses

HYPOTHALAMIC, PITUITARYAldosteronism Clinical features Causes and Treatment. Read more ... » AND OTHER SELLAR MASSES

Pituitary tumors , Pituitary adenomas   :

• Commonest tumors are pitu­itary adenomas. These are benignPheochromocytoma Clinical Features Diagnosis Treatment. Read more ... » and their features depend on the cell type from which they occur.
• They may arise from PRL, GH, ACTHACTH and TSH DEFICIENCY Diagnosis with Treatment. Read more ... », TSHACTH and TSH DEFICIENCY Diagnosis with Treatment. Read more ... », LH and FSH producing cells r;esulting in features of hyperse­cretion of the hormones.
• There is autonomous hormoneAnterior Pituitary Hormones and Disorders. Read more ... » secretion which does not respond to the inhibitory feedback of these hor­mone levels.
• Many of these tumors do not produce hypersecretion features.

Causes of sellar masses

• Arachnoid

  Benign tumors

  Breast

  Carotid arteriovenous fistula

  Chordoma

  Craniopharyngioma

  Cysts

  Dermoid

  Germ cell tumorArbuda or Cancer Ayurvedic Review. Read more ... » (ectopic pinealoma)

  Lactotroph hyperplasia (during pregnancy)

  Lung

  Lymphocytic hypophysitis

  MalignantPheochromocytoma Clinical Features Diagnosis Treatment. Read more ... » tumors

  Meningiomas

  Metastatic

  Pituitary abscess

  Pituitary adenoma (most common sellar mass)

  Pituitary carcinomaArbuda or Cancer Ayurvedic Review. Read more ... » (rare)

  Pituitary hyperplasia

  Primary

  Rathke’s cleft

  Sarcoma

  Somatotroph hyperplasia due to ectopic GHRH

  Thyrotroph and gonadotroph hyperplasia

 

Other neurologic symptoms —

• Cerebrospinal fluid rhinorrhea, caused by inferior extension of the adenoma, is an extremely uncommon presentation.
• Diplopia, induced by oculomotor nerve compression resulting from lateral extension of the adenoma.
• Headaches, presumably caused by expansion of the sella. The quality of the headacheHeadache. Read more ... » is not specific.
• Other neurologic symptomsManagement of Unstable Angina (UA) / NSTEMI Anti-ischemic treatment. Read more ... » that may cause a patient with a sellar mass to seek medicalFatigue diagnosis medicine and treatment. Read more ... » attention include:
• Parinaud syndromeMetabolic,Insulin Resistance Syndrome X Causes Symptoms. Read more ... », a constellation of neuroophthalmologic findings, most often paralysis of upward conjugate gaze, that result from ectopic pinealomas
• Pituitary apoplexyAnterior Pituitary Hormones and Disorders. Read more ... » induced by sudden hemorrhage into the adenoma, causing excruciating headache and diplopia.

Pituitary carcinoma is rare. Craniopharyngiomas :

• These are derived from Rathke’s pouch. They arise near the pituitary stalk and extend to supracellar region.
• They are large, cystic and locally invasive.
• They may be calcified and seen on x-ray and CT. Age of presentation is less than 20 years.
• There is raised intracranial pressureChronic Long-term Complications Of Diabetes Mellitus. Read more ... » with headache, vomitingNausea and Vomiting. Read more ... », papilledema, hydrocephalus, visual field de­fects, cranial nerve damage, weight gain, personality changes, growth retardation.
• There may also be diabetes insipidusHyperglycemic Hyperosmolar State (HHS) Acute Complication Of DM. Read more ... » (if the posterior pituitary is involved).

TreatmentManagement of Unstable Angina (UA) / NSTEMI Anti-ischemic treatment. Read more ... » of pituitary masses

• Surgical resection and radiation after surgery. Patients may require lifelong pituitary hormone replacement.

Other tumors :

• Meningiomas, Histiocytosis X, Glio­mas, Germinomas may also occur.

Lab diagnosis of tumors and masses

• · MRI, CT, visual field examinationHow to take good medical history & examination. Read more ... » and other im­aging techniques.
• · Histopathologic diagnosisManagement of Unstable Angina (UA) / NSTEMI Anti-ischemic treatment. Read more ... » of tumor after surgery.
• · Hormonal evaluation:

1. 1. Basal PRL (prolactin)
2. 2. IGF (insulinHyperglycemic Hyperosmolar State (HHS) Acute Complication Of DM. Read more ... » like growth factor)
3. 3. 24-hour urinary free cortisol (UFC and or over­night oral dexamethasone 1 mg suppression test)
4. 4. FSH and LH levels
5. 5. ThyroidMyxedema coma Diagnosis and Treatment. Read more ... » function tests.

Treatment of hypothalamic and pituitary masses

• Transsphenoidal surgery
• Stereotactic radiotherapy (gamma knife radio­therapy)
• Radiation
• Bromocriptine, the Dopamine agonist for hyperprolactinemia
• Estrogen replacement for bone loss and hypoestrogenem ia
• Growth hormone
• Thyroxine etc.