MR with Ryan and Dr. Kanter: Hypopituitarism and sellar mass

An elderly man with a hx of HTN, HLD who presented to clinic with decreased vision and hypogonadism – MRI demonstrated a 3 cm sellar mass compressing the optic chiasm.  He underwent transsphenoidal resection, which was complicated by hypopituitarism necessitating hormone replacement with levothyroxine, hydrocortisone, and testosterone.
 
DDx for visual field cut -> pituitary adenoma, sellar mass, glaucoma

DDx for sellar mass -> pituitary adenoma, prolactinoma, brain metastases, meningioma/craniopharyngioma, granulomatous disease (sarcoid, TB)

Any sellar mass that causes visual field deficits

Macradenoma vs. Microadenoma – Microadenomas should not cause visual symptoms – and are defined as < 1 cm

A common/serious complication of transphenoidal resection is a CSF leak

TSH will NOT be accurate in pituitary adenoma – you have to test the free T4 as well to determine hyperthyroid state
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