- Types of tumors of the sellar region
- Adamantinomatous craniopharyngioma
- Papillary craniopharyngioma
- Pituicytoma, Granular cell tumor of the sellar region, and spindle cell oncocytoma
- Pituitary adenoma/PitNET
- Pituitary blastoma
- What is the enhancement pattern of a pituitary adenoma with contrast relative to a normal gland?
- Normal gland will enhance immediately after the contrast injection as opposed to adenoma that remains unchanged; however, 30 minutes post-injection, the normal gland loses its enhancement and tumor enhances.
- Differential diagnosis for thickening of the pituitary stalk?
- Lymphoma
- Lymphocytic hypophysitis
- Is most commonly seen during pregnancy or postpartum period
- Unknown reason why an inflammatory/ autoimmune process affecting the pituitary gland and the pituitary stalk (infundibulum) occurs late in pregnancy
- Presentation
- Pituitary failure such as lethargy, amenorrhea, diabetes insipidus and visual disturbance (if there is optic chiasm compression).
- MRI
- A homogeneously enhancing sellar/infundibular mass
- Homogeneously enlarged pituitary gland and stalk, often with a pear-shaped appearance
- T1WI may even show loss of posterior pituitary bright spot (normally present due to vasopressin storage) in cranial diabetes insipidus.
- Treatment
- Generally self limiting
- Where there is a high clinical suspicion (e.g. postpartum, other autoimmune conditions, ipilimumab use, absence of serum markers for sarcoidosis) treatment with steroids and supportive therapy can be initiated.
- However, if the picture is uncertain or no response to steroids biopsy should be performed as it is the only way to make the diagnosis.
- Granulomatous disease
- Hypothalamic glioma
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