Lisa Beutler, endocrinologist extraordinaire, presented a great case of an incidentally-found sellar mass that turned out to be a Rathke’s cleft cyst. He then went on to develop an abscess post-operatively that grew MSSA. Key learning points:
Sellar Masses could be . . .
–Rathke’s cleft cyst (not uncommon!)
If you suspect a pituitary tumor, ask is it:
Hypersecretory: history and exam helpful, ask about hyperthyroid symptoms, look for acromegaly (check a driver’s license), look for cushingoid features
Hyposecretory: need labs! Check FSH, LH, AM cortisol and stim maybe, TSH and T4, IGF (marker of GH) and prolactin*
Pearl: prolactin is the sed rate of the pituitary, if it’s up, something’s wrong!