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Neurology of the pituitary gland
  1. J R Andersona,
  2. N Antounb,
  3. N Burnetc,
  4. K Chatterjeed,
  5. O Edwardse,
  6. J D Pickardf,
  7. N Sarkiesg
  1. aDepartment of Neuropathology, Box 235, bDepartment of Neuroradiology, Box 219, cDepartment of Neuro-oncology, Box 193, dDepartment of Diabetes and Endocrinology Box 157, eDepartment of Diabetes and Endocrinology, Box 49, fDepartment of Neurosurgery, Box 167, gDepartment of Ophthalmology, Box 41, Addenbrooke’s Hospital, Cambridge, UK
  1. Professor JD Pickard, Department of Neurosurgery, Box 167, Addenbrooke’s Hospital, Cambridge CB2 2QQ, UK. Telephone 0044 1223 336946.

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This review will focus on those aspects of pituitary disease immediately relevant to neurologists and neurosurgeons when assessing and counselling patients. It is essential to adopt a multidisciplinary approach to the diagnosis and management of pituitary disease as emphasised by the recently published guidelines from the Royal College of Physicians of London.1-4

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Differential diagnosis of neoplasms and “tumour-like” lesions of the sellar region2

Range of pathology presenting in the sellar region

The commonest lesions presenting in this region are pituitary tumours (incidence of 15–20/million/year), including adenomas and craniopharyngiomas, aneurysms, and meningiomas, but many other diseases need to be considered (table 1).

Neurological presentations of pituitary disease

”Pituitary incidentalomas” may be disclosed when investigating unrelated disease (fig 1). Although figures from 5% to 27% have been quoted for the incidence of subclinical adenomas at postmortem, far fewer are of significant size—that is, over 5 mm in diameter with deviation of the stalk and unilateral enlargement of the gland. Careful endocrine and visual assessments are required and, where no abnormalities are found, most can be managed conservatively with follow up MRI.5-8

Figure 1

(A) Normal appearance of pituitary gland. Sagittal TI weighted image. Note the bright signal from the posterior lobe of the pituitary. More posteriorly the dorsum sella (arrow head) is shown as linear high signal (marrow) surrounded by low signal (dense cortex). (B) Microadenoma on the left side. This has a lower signal than normal pituitary. The normal pituitary and cavernous sinus show enhancement after gadolinium injection.

Pituitary disease often presents insidiously and in retrospect might have been detected earlier. The symptoms of hormonal hypersecretion in endocrinologically active tumours will obviously present before evidence of suprasellar or parasellar extension. Although somatic changes usually bring the growth hormone secreting adenoma to medical attention first, the neurologist may encounter nerve entrapment (particularly the carpal tunnel syndrome), proximal myopathy (weakness disproportionate to the increased body …

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