General overview of the sellar supra-sellar tumors

1. Sellar/Supra-
sellar tumors
By:
Dr Shaheer Anwar

2.  Tumors of pituitary Gland constitute 5-10%of the
intracranial tumors.
 They arise from the anterior portion of the gland
and are usually benign.
A. Pituitary adenomas.
B. Cranipharyngiomas.
C. Optic nerve (Glioma) Astrocytoma.
D. Suprasellar meningioma.
E. Meningioma of optic nerve sheath.
F. Suprasellar epidermoid/dermoid.

4. Classification:
 Classic classification:
1. Eosinophilic cells: Prolactin, Growth
hormone.
2. Basophilic cells: Adrenocorticotrophic
hormone, thyroid stimulating hormone,
Gonadotrophic hormones
3. Chromophobe cells: Non functioning.

5.  Present classification:
Immuo-histochemical techniques permit a
classification based on the hormone type secreted.
1. GH secreting tumor. (20-25%)
2. Prolactinoma. ( 25-50%)
3. ACTH secreting tumor. (5-10%)
4. TSH secreting tumor. (Rare)
5. FSH/LH secreting tumor.(Rare)
6. Inactive

6. Clinical presentation of the
patients:
 Clinical presentation of the patients depends
upon the size of the tumor and the type of the
tumor. Depending upon the size tumors are
divided into 2 types:
Large tumors(macro-adenomas).
Small tumors <1cm(micro-adenomas).

7. Coronal and saggital sections of
pituitary microadenoma on MRI
brain:

8. Coronal and saggital sections of
pituitary macroadenoma on MRI
brain:

9. Local Mass Effects:
 Headache.
 Visual field Defects: Pressure on the inferior
aspect of the optic chiasma usually causes
superior temporal quadrantanopia initially, with
progression to bitemporal hemianopia.
 Cavernous sinus compression: Lateral
expansion compress the nerves lying within the
cavernous sinus.
vertical compression obstructs the foramen of
munro causing hydrocephalus and
hypothalamic compression.

10. Endocrine Effect:
 Hypersecretion:
The clinical syndrome produced is dependent on the hormone secreted.
Growth hormone:
Excess GH secretion in adult causes Acromegaly.
Excess secretion in childhood causes Gigantism.
Prolactin:
Infertility.
Amenorrhea.
Galactorrhea.
ACTH:
Excess secretion of ACTH causes all the features of the Cushing’s
syndrome.
 Hyposecretion.

11. Investigations:
X-ray Skull: Large
tumors causes
expansion
or ballooning of the
pituitary fossa or
may erode the
floor.

12.  CT Scan Brain:
CT brain with
contrast enhancement
is very useful in
demonstrating the
tumors expanding
into the suprasellar
compartment.

13.  MRI: It gives more details regarding tumor
extension and involvement of the vessels.

14.  Hormonal profile:
Cortisol levels.
TSH, T3, T4 levels.
FSH/LH levels.
Prolactin levels.

15. Management:
 Drug Therapy: Dopamine agonists lower th
abnormal concentrations and the tumor shrinks agents include bromocriptine
and carbergoline. Somatostatins analogues e.g. octreotide. GH receptor
antagonists e.g. pegvisomant.
 Operative Approach:
From below: Transphenoidal approach is through incisions:
Sublabial incision
Transnasal endoscopic approach.
From above: Frontal craniotomy. This approach is reserved for large frontal
and lateral extensions.
o Radiotherapy: Pituitary adenomas are radiosensitive and
external irradiation is commonly employed. Stereotactic surgery is also used.
Radioactive seeds of yttrium or gold are implanted in the pituitary fossa.

16. Treatment Selection:
Treatment choice depends upon the
1. Presenting problems and patient’s
reuirements.
2. Patient’s age.
3. Preference and experience of the treatment
centre.