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Chapter 16 – Clinically Nonfunctioning Sellar Masses

Peter J. Snyder,
Shlomo Melmed

  Natural History of a Pituitary or Parasellar Mass
  Types of Sellar Masses
  Pituitary Adenomas
  Pituitary Hyperplasia
  Lymphocytic Hypophysitis
  Benign Tumors, Nonpituitary
  Malignant Tumors

  Etiology of Pituitary Adenomas
  Clinical Features
  Neurologic Features
  Endocrinologic Features

  Diagnosis
  Utility of Diagnosing a Clinically Nonfunctioning Sellar Mass
  Imaging of the Sellar Region
  Endocrinologic Tests
  Histologic Evaluation
  Approach to the Patient With a Sellar Mass

  Treatment
  Surgery
  Radiation
  Pharmacologic Treatment
  Observation

Many types of lesions present as a mass within or near the sella turcica (Table 16-1). The majority of sellar masses are pituitary adenomas, even those that are not obviously associated with clinical syndromes. The majority of these clinically nonfunctioning pituitary adenomas are gonadotroph adenomas, but some are relatively silent lactotroph, somatotroph, corticotroph, and thyrotroph adenomas. Determining whether …