VA AM Report: Sellar Masses

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 . . .

–pituitary adenoma
–metastatic disease
–sarcoidosis
–Rathke’s cleft cyst (not uncommon!)
–Infection
–CNS lymphoma

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!

 

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