Diagnosis

Many patients with nonpituitary sellar and suprasellar tumors have symptoms of anterior pituitary hormone failure. The most common hormone insufficiency is gonadotropin deficiency. Hypogonadism is diagnosed by a decrease in serum FSH, LH, and testosterone levels. Hyperprolactinemia is often detected, particularly in patients with craniopharyngiomas, meningiomas, or cystic lesions (87).

Visual field impairment and decreased visual acuity are frequent events, because of the proximity of the optic nerves, chiasm, and optic tracts to the sella turcica. The tendency of these tumors to infiltrate parasellar structures causes cranial neuropathy. Tumors that are obstructing cerebrospinal fluid (CSF) flow (craniopharyngioma, meningioma, and germinoma) increase intracranial pressure. This event is characterized by visual impairment and headaches. Masses compressing the deep subfrontal region of the brain may induce personality changes and dementia. In addition, these lesions may impair hypothalamic function and disrupt appetite control, causing polyphagia and massive obesity or starvation (87-89).

Although it is difficult to reach a specific preoperative diagnosis on MRI, many lesions have characteristic findings that are useful in the differential diagnosis. For example, calcifications are suggestive of craniopharyngiomas, meningiomas, chordomas, teratomas, and gliomas. Erosion of the sella floor is frequently observed in meningiomas of the middle fossa and Rathke's cleft cyst (87).

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