3,4 Pituitary tumors may present with syndromes related to local mass effects or hormonal excess.
Further forward at the level of the orbits the optic nerve is abnormal on both sides. On the top-left unenhanced and enhanced CT-images, the main differential diagnosis of the enhancing mass would include meningioma, pituitary adenoma and an aneurysm. At medical school they teach you that a rare manifestation of a common lesion is more likely than a rare abnormality. Clinical pituitary apoplexy is not synonymous with hemor rhage into a pituitary adenoma. Gliomas can occur in any part of the brain and the optic chiasm is a common location, particularly in patients with neurofibromatosis type 1. Some authors have previously defined “aggressive” PAs as those that respond poorly to therapy or recur, and “invasive” PAs as those that extend into adjacent anatomical structures such as the cavernous sinus, sphenoid sinus, or surrounding bone In an effort to quantify and more objectively define invasive growth in PAs, Knosp et al. Usually the diagnosis of a macroadenoma is straightforward.These images are of a transsphenoidal resection of a pituitary macroadenoma. 3 One of the most difficult differential diagnoses on CT is aneurysm versus meningioma.
The clinical picture of an intrasellar arachnoid cyst resembles that of a nonfunctional pituitary adenoma. Intrasellar location of schwannoma is extremely rare, although intracranial schwannomas account for up to 8% of all primary brain tumors. Seventy percent of these tumors present between the ages of 30 and 50 years old. To date, our ability to predict the Recent progress in the genetics of endocrine tumors has resulted in an increased recognition of the genes that predispose to the development of pituitary adenomas in the context of multiple neoplasia syndromes (PA can be divided by size into microadenoma (< 1 cm) and macroadenoma (> 1 cm), the latter being responsible for 40% of the cases (Although only 0.2% of pituitary tumors are classified as malignant, defined by distant metastasis, they cause significant morbidity.
The best images to see hamartomas on are enhanced sagittal T1-weighted MR images. In general, all extra-axial masses , i.e. This is another example of a right-sided optic nerve glioma with enhancement after gadolinium. A 39-yr-old man presented a 10-month history of visual disturbance and decreased libido. Unenhanced CT shows the calcifications more clearly. These T1, T2 and T1-weighted images after gadolinium demonstrate another Rathke's cleft cyst located in the pituitary gland. The following case concerns a 9-year-old male with a history of headache, nausea and vomiting.T2- and T1 weighted sagittal images of the same patient show a similar mass in the epiphysial area.
On an unenhanced scan, approximately 70% of all pituitary microadenomas can be detected.
lntratumoral hemorrhage can vary from small focal hematomas (Figs.
There is a large intrasellar and suprasellar mass with cystic and enhancing components as well as calcifications. These consecutive coronal MR-images show the mass at the optic chiasm and the swollen optic nerves. The most common intracranial tumor in adults is the meningioma with 20% of occurring at the skull base. Purely intrasellar pituitary masses have a similar differential as the more generic pituitary region mass gamut, or the mnemonic SATCHMO, although some entities are far more common than others. ScienceDirect ® is a registered trademark of Elsevier B.V.URL: https://www.sciencedirect.com/science/article/pii/B9780123750976100344URL: https://www.sciencedirect.com/science/article/pii/B9780128041697000210URL: https://www.sciencedirect.com/science/article/pii/B9780128041697000209URL: https://www.sciencedirect.com/science/article/pii/B9780128012383650869URL: https://www.sciencedirect.com/science/article/pii/B978044459602400023XURL: https://www.sciencedirect.com/science/article/pii/B9781416025894000036URL: https://www.sciencedirect.com/science/article/pii/B978012801238366169XURL: https://www.sciencedirect.com/science/article/pii/B9780128012383641995URL: https://www.sciencedirect.com/science/article/pii/B9781416058977000251URL: https://www.sciencedirect.com/science/article/pii/S0079612310820102Encyclopedia of Endocrine Diseases (Second Edition), 2017FIPA syndrome is defined as a familial presentation of any type of Nonsquamous Lesions of the Nasal Cavity, Paranasal Sinuses, and NasopharynxDiagnostic Surgical Pathology of the Head and Neck (Second Edition)Pituitary Tumors Associated With Multiple Endocrine Neoplasia SyndromesEncyclopedia of Endocrine Diseases (Second Edition)Encyclopedia of Endocrine Diseases (Second Edition)Leibel and Phillips Textbook of Radiation Oncology (Third Edition)ScienceDirect ® is a registered trademark of Elsevier B.V. PA are associated with hormonal disturbances and compression symptoms like headaches, visual disturbances, and hypopituitarism due to mass effect.
The investigation of choice is a contrast-enhanced cranial MRI, which reveals an intrasellar mass. The two most frequent forms are familial isolated pituitary adenomas (FIPA) and multiple endocrine neoplasia type 1 syndrome (MEN1), which are responsible for 2%–3% and 3%, respectively, of PA (Although the incidence varies according to age, gender, and ethnic group, women are reported to present more frequently than men; this perhaps may reflect the relative contribution of prolactinomas and corticotrophin secreting tumors.