[en] More than thirty types of tumors in the sellar region can mimic pituitary adenoma on, magnetic resonance imaging. When they exist, clinical manifestations are not necessarily highly contributive to diagnosis. Headache, visual impairment, signs of antepituitary insufficiency or possible dysmenorrhea with galactorrhea attributed to hyperprolactinemia due to compression of the dopaminergic axis are not specific and may be misleading. Clinical signs of diabetes insipidis and polyphagia are however suggestive of non-pituitary tumors. Consequently, high-resolution imaging (MRI) and sometimes particular diagnostic circumstances (post partum for hypophysitis for example, or breast cancer for metastasis) orient the diagnosis. More rarely tumor enlargement, for example in certain germ cell tumors, provides a clue.
Disciplines :
Endocrinology, metabolism & nutrition
Author, co-author :
Rohmer, V.
Chanson, Philippe
Dupas, B.
Beckers, Albert ; Université de Liège - ULiège > Département des sciences cliniques > Endocrinologie
BARRANDE G, KUJAS M, CANCEL A, TURPIN G, BRUCKERT E, KUHN JM, LUTON JP. Les tumeurs à cellules granuleuses. Des tumeurs rares de la neurohypophyse. Presse méd 1995 ; 24 : 1376-80.
BELL NH. Endocrine complications of sarcoidosis. Endocrinol Metab Clin North Am 1991 ; 20 : 645-54.
BENSAID A, NAVARRO C, CEJAS C, ARHAN JM, GANGI A, DIETEMANN JL. Aspect TDM et IRM des kystes épidermoïdes et dermoïdes intracrâniens. Feuillets de Radiologie 1994 ; 34 : 55-65.
CAPARROS-LEFEBVRE D, PRUVO JP, REMY M, WALLAERT B, PETIT H. Neuroradiologic aspects of Chester-Erdheim disease Am J Neuroradiol 1995 ; 16 : 735-40.
CAPELLAN JIL, OLMEDO LC, MARTIN JM, MARIN MDM. VILLANUEVA MG, ZARZA FM, BLASCO HDLC Intrasellar mass with hypopituitarism as a manifestation of sarcoidosis. J Neurosurg 1990 ; 73 : 283-86.
CZARNECKI EJ and SPICKLER EM. MR Demonstration of Wegener granulomatosis of the infundibulum, a cause of diabetes insipidus. Am J Neuroradiol 1995 ; 16 : 968-70.
DELSEDIME M, AGUGGIA R, CANTELLO I, CHIADO C, NICOLA G, TORTA R and GILLI M. Isolated hypophyseal tuberculoma: case report. Clin Neuropathol 1988 ; 7 : 311-13.
DOMINGUE JN, WILSON CB. Pituitary abscess. Report of seven cases and review of the literature. J Neurosurg 1977 ; 46 : 601.
DONADIEU J, THOMAS C, EMILE JF, TEILLAC-HAMEL D, LANDMAN-PARKER J, AUBIER F, FAGNOU C, BROUSSE N. Histiocytose langherhansienne : mise au point. Médecine Thérapeutique 1996 ; 2 : 441-51.
DORAISWAMY PM, POTTS JM, AXELSON DA, HUSAIN MM, LURIE SN, NA C, ESCALONA PR, MCDONALD WM, FIEGEL GS, ELLINWOOD EH, BOYKO OB, KRISHNAN KR. MR assessment of pituitary gland morphology in healthy volunteers : age- and gender related differences. Am J Neuroradiol 1992 , 13 : 1295-99.
DUNGER DB, BROADBENT V, YEOMAN E, SECKL JR, LIGHTMAN SL, GRANT DB, PRITCHARD J. The frequency and natural history of diabetes insipidus in children with Langerhans-cell histiocytosis. N Engl J Med 1989 ; 321 : 1157-62
ELSTER AD, CHEN MYM, WILLIAMS DW, KEY LL. Pituitary gland : MR imaging of physiologic hypertrophy in adolescence. Radiology 1990 ; 174 : 681-5.
ESPOSITO V, FRAIOLI B, FERRANTE L, PALMA L. Intrasellar tuberculoma: case report. Neurosurgery 1987 ; 21 : 721-3.
FRANK G, GALASSI E, FABRIZI AP, FRANK F, MANETTO V. Primary Intrasellar Germinoma : Case Report. Neurosurgery 1992 ; 30 : 786-88.
FREDA PU, SILVERBERG SJ, POST KD, WARDLAW SL. Hypothalamic-pituitary sarcoidosis. Trends Endocrinol Metab 1992 ; 3 : 321-25.
FUJISAWA I, ASATO R, OKUMURA R, NAKANO Y, SHIBATA T, HAMANAKA D, HASHIMOTO T, KONISHI J. Magnetic Resonance Imaging of Neurohypophyseal Germinomas. Cancer 1991 ; 68 : 1009-14.
GONZALES JG, ELIZONDO G, SALVIDAR D, NANEZ H, TODD LE, VILLARREAL JZ. Pituitary gland growth during normal pregnancy : an in vivo study using magnetic resonance imaging. Am J Med 1988 ; 85 : 217-20.
GRAIF M, PENNOCK JM. MR imaging of histiocytosis X in the central nervous system. Am J Neuroradiol 1986 ; 7 : 21-23.
GRISOLI F, VINCENTELLI F, RAYBAUD C, HARTER M, GUIBOUT M, BALDINI M. Intrasellar meningioma. Surg Neurol 1983 ; 20 : 36-41.
HAYAKAWA K, KONISHI Y, MATSUDA T, KURIYAMA M, KONISHI K, YAMASHITA K, OKUMURA R, HAMANAKA D. Development and aging of brain midline structures : assessment with MR imaging. Radiology 1988 ; 172 : 171-77.
JENKINS PJ, CHEW SL, LOWE DG, AFSHAR F, CHARLESWORTH M, BESSER GM, WASS JAH. Lymphocytic hypophysitis : unusual features of a rare disorder. Clin Endocrinol 1995 ; 42 : 529-34.
KEPES JJ, KEPES M. Predominantly cerebral forms of histiocytosis X. A reappraisal of « Gagel's hypothalamic granuloma », « granuloma infiltrans of the hypothalamus » and Ayala's disease with a report of four cases. Acta Neuropathol 1969 ; 14 : 77-98
KHAWK T, MANJI H, BRITTON J, SCHON F. Neurosarcoidosis : demonstration of meningal disease by gadolinium enhanced magnetic resonance imaging. J Neurol Neurosurg Psychiatry 1991 , 54 : 499-502.
KO JC, YANG PC, HUANG TS, YEH KH, KUO SH and LUH KT. Panhypopituitarism caused by solitary parasellar metastasis from lung cancer. Chest 1994 ; 105 : 951-53.
KUMMER R, STORCH B, RANCH M, KRAUSE KM. A case of multiple intracranial tuberculomas followed by serial computerized tomography. Nervenarzt 1981 , 52 : 344-47
LAFITTE C, AESCH B, HENRY-LEBRAS F, FETISSOF F, JAN M. Granular cell tumor of the pituitary stalk. J Neurosurg 1994 ; 80 : 1103-07.
LAWTON FG, BEARDWELL CF, SHALET SM, DAWS RA. Hypothalamic-pituitary disease as the sole manifestation of sarcoidosis. Postgrad Med J 1982 ; 58 : 771-72.
LEAVIIT RY and FAUCI AS. Less common manifestations and presentations of Wegener's granulomatosis. Current opinion in Rheumatology. 1992 ; 4 : 16-22.
LINDHOLM J, RASMUSSEN P, KORSGAARD O. Intrasellar or pituitary abscess. J Neurosurg 1973 ; 38 : 616.
LIU DP, SZE G Intracranial sarcoidosis on gadolinium-enhanced MRI. Neuroradiology 1990 ; 33 : 189.
LOHR KM, RYAN LM, TOOHILL RJ and ANDERSON T. Anterior pituitary involvement in Wegener's granulomatosis. J. Rheumatol 1988 ; 15 : (5) 855-57.
LURIE SN, DORAISWAMY PM, HUSAIN MM, BOYKO OB, ELLINWOOD EH, FIGIEL GS, KRISHNAN KRR. In vivo assessment of pituitary gland volume with magnetic resonance imaging : the effect of age J Clin Endocrinol Metab 1990 ; 71 : 505-08.
MAGHNIE M, GENOVESE E, ARICO M, VILLA A, BELUFFI G, CAMPANI R, SEVERI F. Evolving pituitary hormone deficiency is associated with pituitary vasculopathy : dynamic MR study in children with hypopituitarism, diabetes insipidus, and Langerhans cell histiocytosis. Radiology 1994 ; 193 493-99.
MAYR NA, YUH ATC, MUHONEN MG, KOCI TM, TALI ET, NGUYEN HD, BERGMAN RA and JINKINS JR. Pituitary metastases: MR findings. J Comput Assist Tomo 1993 ; 17 (3) 432-37.
MIDHA R, JAY V, SMYTH HS. Transsphenoidal Management of Rathke's Cleft Cysts. A clinicopatholosical review of 10 Cases. Surg Neurol 1991 ; 35 : 446-54.
MISSLER U, MACK M, NOWAK G. Pituitary sarcoidosos. Klin Wochenschr 1990 ; 68 : 342-45.
MODIGLIANI E, BERESSI N, IBA-ZIZEN MT, DUMAS JL, COHEN R, MIKOL J, Les hypophysites lymphocytaires : aspects anatomo-pathologiques, cliniques, radiologiques et thérapeutiques. Rev Franç Endocrinol Clin 1993 ; 34 : 499-09.
NAYLOR MF, SCHEITHAUER BW, FORBES GS, TOMLINSON FH, YOUNG WF. Rathke Cleft Cyst : CT, MR, and Pathology of 23 Cases. J Comput Assist Tomo 1995 ; 19 : 853-59.
NISHIO S, MIZUNO J, BARROW DL, TAKEI Y, TINDALL GT. Isolated histiocytosis X of the pituitary gland : case report. Neurosurgery 1987 ; 21 : 718-21.
NISHIO S, TSUKAMOTO H, FUKUI M and MATSUBARA T. Hypophyseal metastatic hypernephroma mimicking a pituitary adenoma. Case report. Neurosurgery 1992 ; 15 : 319-22.
PERLOFF JJ, LEMAR HJ, VISHNU FREDDY BV, CARTER TE and MCDERMOTT MT. Metastatic adenocarcinoma of the prostate manifested as a sellar tumor. Southern Med J 1992 ; 85 : 1140-1.
PEYSTER RG, HOOVER ED, VISCARELLO RR, MOSHANG T, HASKIN ME. CT appearance of the adolescent and preadolescent pituitary gland Am J Neuroradiol 1983 ; 4 : 411-14.
PIGEAU I, SIGAL R, HALIMI P, COMOY J, DOYON D. MRI features of craniopharyngiomas at 1.5 tesla. J. Neuroradiol 1988 : 15 : 276-87.
POULLIN P, DI COSTANZO V, LE POMMELET C, GABRIEL B. Diabète insipide révélant une métastase d'un adénocarcinome mammaire. Rev Méd Int 1995 ; 16 : 444-6.
RANDALL RV, LAWS ER Jr, ABBOUD CF. Clinical presentations of craniopharyngioma : a brief review of 300 cases. In : Givens JR. ed. The Hypothalamus. Year Book Medical Publishers. Chicago : 1984: 321.
RESNICK D, GREENWAY G, GENANT H, BROWER A, HAGHIGHI P, EMMET M. Erdheim-Chester disease. Radiology 1982 ; 142 : 289-95.
ROBERTS GA, EREN E, SINCLAIR H, PELLING M, BURNS A, BRADFORD R, MAURICE-WILLIAMS R, BLACK CM, FINER N and BOULOUX P-MG. Two cases of Wegener's granulomatosis involving the pituitary. Clin Endocrinol 1995 ; 42 : 323-28.
ROHMER V., SAINT-ANDRE JP, ALHENC-GELAS F, CORVOL P, BIGORGNE JC. Angiotensin I-Converting Enzyme in a Suprasellar Germinoma. Am J Clin Pathol 1987 ; 87 : 281-84.
ROHRINGER M, SUTHERLAND GR, LOUW DF, SIMA AAF. Incidence and clinicopathological features of meningioma. J. Neurosurg 1989 ; 71 : 665-72.
ROSELETE A, CABRAL AR, KRAUS A and ALARCON-SEGOVIA D. Diabetes insipidus secondary to Wegener's granulomatosis : report and review of the literature. J Rheumatol 1991 ; 18 : 761-5.
Ross DA, NORMAN D, WILSON CB. Radiologic Characteristics and Results of Surgical Management of Rathke's Cysts in 43 Patients. Neurosurgery 1992, 30 : 173-79.
SAEGER W, PUCHNER MJ, LUDECKE DK. Combined sellar gangliocytoma and pituitary adenoma in acromegaly or Cushing's disease. A report of 3 cases. Virchows Arch (Germany), 1994 ; 425 : 93-99.
SCHLIENGER JL, MAITROT D, MOHRT M, ROHMER V, POUPLARD A, FABRE M, DICOP C, SIMON C, TONGIO MT. Adénohypophysite lymphocytaire pseudo-adénomateuse du post-partum : une pathologie immune responsable d'insuffisance hypophysaire antérieure. Ann Endocrinol (Paris) 1987 ; 48 : 58-62.
STERN BJ, KRUMHOLZ A, JOHNS C, SCOTT P, NISSIM J. Sarcoidosis and its neurological manifestations. Arch Neurol 1985 ; 42 : 909-17.
SUZUKI M, TAKASHIMA T, KADOYA M, KONISHI H, KAMEYAMA T, YOSHIKAWA J, GABATA T, ARAI K, TAMURA S, YAMAMOTO T, KAWAHARA K. Height of normal pituitary gland on MR imaging : age and sex differentiation. J Comput Assist Tomogr 1990 ; 14 : 36-39.
SWARTZ JD, RUSSEL KB, BASILE BA, O'DONNELL PC, POPKY GL. High-resolution computed tomographic appearance of the intrasellar contents in women of childbearing age. Radiology 1983 ; 147 : 115-17.
THODOU E, ASA SL, KONTOGEORGOS G, KOVACS K, HORVATH E, EZZAT S. Clinical Case Seminar : Lymphocytic Hypophysitis : Clinicopathological Findings J Clin Endocrinol Metab 1995 ; 80 : 2302-11.
TIEN RD, NEWTON TH, MCDERMOTT MW, DILLON WP, KUCHARCZYK J. Thickened pituitary stalk on MR images in patients with diabetes insipidus and Langerhans cell histiocytosis Am J Neuroradiol 1990; 11 : 703-08.
TIMSIT J, VALEYRE D, CHANSON P, MOURIER K, CALLAT-VIGNERON N, MIKOL J, LUBETZKI J. Isolated pseudo-tumoral sarcoidosis of the hypothalamic pituitary area. Europ J Med 1993 ; 2 : 505-06.
VEYSSIER-BELOT C, CACOUB P, CAPARROS-LEFEBVRE D, WECHSLER J, BRUN B, REMY M, WALLAERT B, PETIT H, GRIMALDI A, WECHSLER B, GODEAU P. Erdheim-Chester Disease. Clinical and Radiologic Characteristics of 59 Cases. Medicine 1996 ; 75 : 157-69.
WAGNER KB, KHAN A, MIR R and HERMAN PG. Thymic carcinoma arising from long standing thymoma and presenting with pituitary metastases. Computerized Medical Imaging and Graphics 1991 ; 15 : (6) 411-14.
WAITE RJ, DOHERTY PW, LIEPMAN M, WODA B. Langerhans cell histocytosis with the findings of Erdheim-Chester disease. Am J Roentgenol 1988 ; 150 : 869-71.
WILLMAN CL, BUSQUE L, GRIFFITH BB, FAVARA BE, MCCLAIN KL, DUNCAN MH, GILLILAND DG. Langerhans'cell histiocytosis (histiocytosis X) - a clonal proliferative disease. N Engl J Med 1994 ; 331 : 154-60.
WOLPERT SM, MOLITCH ME, GOLDMAN JA, WOOD JB. Size shape and appearance of the normal female pituitary gland. Am J Roentgenol 1984 ; 143 : 377-81.
WU JK, HEDGES TR, ANDERSON ML, FOLKERTH RD. Surgical reversal of a subacute complete unilateral visual loss from an ovarian metastasis to the pituitary gland. Neurosurgery 1992 ; 31 : 349-52.