Merck Manual

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Pituitary Lesions

By

John D. Carmichael

, MD, Keck School of Medicine of the University of Southern California

Last full review/revision Mar 2021| Content last modified Mar 2021
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Patients with hypothalamic-pituitary lesions generally present with some combination of

  • Symptoms and signs of a mass lesion: headaches, altered appetite, thirst, visual field defects—particularly bitemporal hemianopia or the hemifield slide phenomenon (images drifting apart)

  • Imaging evidence of a mass lesion as an incidental finding

  • Hypersecretion or hyposecretion of one or more pituitary hormones

The most common cause of hypopituitary or hyperpituitary secretion is a pituitary or hypothalamic tumor. A pituitary tumor tends to produce an enlarged sella (sella turcica). Alternatively, an enlarged sella may represent empty sella syndrome.

Empty sella syndrome

In this disorder, the sella appears empty because it is filled with cerebrospinal fluid, which flattens the pituitary gland against the wall of the sella. The syndrome may be

  • Congenital

  • Primary

  • Secondary to injury (eg, ischemia after childbirth, surgery, head trauma, radiation therapy)

Pituitary function in patients with empty sella syndrome is frequently normal. However, hypopituitarism Generalized Hypopituitarism Generalized hypopituitarism refers to endocrine deficiency syndromes due to partial or complete loss of anterior lobe pituitary function. Various clinical features occur depending on the specific... read more may occur, as may headaches and visual field defects. Occasionally, patients have small coexisting pituitary tumors that secrete growth hormone (GH), prolactin, or adrenocorticotropic hormone (ACTH).

Diagnosis can be confirmed by CT or MRI.

No specific therapy is needed for an empty sella alone.

Anterior lobe lesions

Hyposecretion of anterior lobe hormones (hypopituitarism Generalized Hypopituitarism Generalized hypopituitarism refers to endocrine deficiency syndromes due to partial or complete loss of anterior lobe pituitary function. Various clinical features occur depending on the specific... read more ) may be generalized, usually due to a pituitary tumor, or is idiopathic or may involve the selective loss of one or a few pituitary hormones.

Posterior lobe lesions

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