From the Guidelines
Suprasellar adenomas primarily manifest through symptoms related to compression of nearby structures and hormonal disturbances, typically presenting with visual field defects, headaches, and hormonal imbalances, as evidenced by recent studies 1. These tumors can cause a range of symptoms depending on their location, size, and hormonal function. The most common symptoms include:
- Visual field defects, most commonly bitemporal hemianopsia, due to compression of the optic chiasm
- Headaches, which can be persistent and worsen with time
- Hormonal manifestations, such as:
- Hyperprolactinemia (leading to galactorrhea, amenorrhea, and decreased libido)
- Growth hormone excess (acromegaly)
- ACTH excess (Cushing's disease)
- Thyroid-stimulating hormone excess (hyperthyroidism)
- Hypopituitarism, resulting in deficiencies of multiple hormones, including cortisol, thyroid hormone, sex hormones, and growth hormone, leading to symptoms such as fatigue, weakness, cold intolerance, and decreased sexual function. In severe cases, suprasellar extension can cause hypothalamic dysfunction, hydrocephalus from third ventricle compression, or cavernous sinus invasion leading to cranial nerve palsies. Early diagnosis and treatment with surgical resection, radiation therapy, or medical management with dopamine agonists (for prolactinomas) can prevent permanent visual and hormonal complications, as recommended by recent guidelines 1. It is essential to consider the individual patient's circumstances and tailor the treatment approach accordingly, taking into account the latest evidence and guidelines 1.
From the Research
Clinical Manifestations of Suprasellar Adenoma
The clinical manifestations of suprasellar adenoma (pituitary gland tumor) can vary depending on the type and location of the tumor. Some common manifestations include:
- Visual symptoms, especially for type III suprasellar adenomas 2
- Menstrual disorders and visual changes in patients with suprasellar ectopic pituitary adenomas 3
- Headaches in patients with clival ectopic pituitary adenomas 3
- General malaise and visual disturbances 4
- Muscle weakness and finger tremor due to thyrotoxicosis after pituitary adenomectomy 5
Hormone-Secreting Subtypes
Suprasellar adenomas can be classified into different hormone-secreting subtypes, including:
- Nonfunctioning adenomas (36.5%) 2
- ACTH-secreting adenomas (34.6%) 2
- Growth hormone-secreting adenomas 6
- FSH-producing pituitary adenomas 5
Anatomic Subtypes
Suprasellar adenomas can be classified into different anatomic subtypes, including:
- Type I: originating from the intrasellar pituitary gland 2
- Type IIa: originating from the subdiaphragmatic part of the pituitary stalk 2
- Type IIb: originating from the supradiaphragmatic part of the pituitary stalk 2
- Type III: originating from the suprasellar peri-infundibular region 2
Diagnostic Challenges
Diagnosing suprasellar adenomas can be challenging due to their atypical growth patterns and locations. Imaging examinations such as MRI and CE-FIESTA can be useful in depicting the connection between the tumor and the normal pituitary gland 4. However, surgery is often the only way to confirm the tumor origin 2.