Pituitary and Sellar region masses

Question 1

Majority of sellar region masses

Answer 1

pituitary adenomas (85%)
equiv to WHO grade I

Others are treated by surgical resection unless medical therapies available

Most uncommon: Rathke cleft cyst or sellar region masses (piuicytoma, spindle cell oncocytoma, hypophysistis) mimic pituitary adenomas on neuroimaging and mimic clinically non functioning pituitary adenomas (mass effect or visual disturbance)

Middle aged adults except craniopharyngioma (5-15 y and 45-60 y peaks)

Question 2

Causes of pituitary adenoma

Answer 2

MEN (mult endocrine neoplasia)
AIP (familial isolated prolactinoma)

-above are in pediatric pop with germline mutation correlation

Families
Gonadotrophs: FSH/LH
Prolactin/TSH/GH
ACTH

Question 3

Does size equal aggressiveness for pituitary tumors?

Answer 3

No

Most are still WHO grade I

Question 4

Genes in pituitary tumors

Answer 4

MEN1
CDKN1B
PRKAR1A
AIP

Genes don’t play much of a role in SPORADIC forms

Question 5

Intervention for pituitary adenomas (most common)

Answer 5

surgical intervention

Question 6

Work-up of pituitary adenoma

Answer 6

H+E
Reticulin
CAM5.2
Synaptophysin (see packaging granules)
PRL
GH
ACTH
FSH
Estrogen receptor

Question 7

Prolactinomas in young women and ACTH adenomas are almost always

Answer 7

microadenomas

85%

Question 8

Hormonally inactive (non-secretors) generally present with

Answer 8

sx of mass effects

HA
Visual field deficits
CN palsies
-ptosis
-diplopia

Pituitary hormone deficits
Panhypopituitarism
Rarely: seizures, stroke, CSF leak