Endocrine Abstracts

Introduction: The differential diagnosis of nonpituitary sellar masses is broad. Clinical presentation may be similar to that of pituitary adenomas. Sometimes certain findings are particular to some lesions and may help in their differentiation. Correct preoperative diagnosis is important to better guide therapeutic management. The aim of this work was to analyze patients with parasellar lesions (craniopharyngiomas excluded), attended in the Department of Endocrinology of our hospital.

Methods: We studied clinical presentation, laboratorial and imaging results of different parasellar lesions of 47 patients before and after treatment.

Result: Sixty-six percent female, mean age 45.2±17.4 years old. Meningiomas (18) and Rathke’s cleft cyst (16) were the most frequent lesions. We also found arachnoid cysts (5), chordomas (3), gangliogliomas (2), germinomas (2) and hamartoma (1). At presentation 80.9% of patients had visual complaints, 46.8% headaches. Pre-operatory evaluation: 26.2% with hypogonadism, 21.4% hypothyroidism, 11.9% adrenal and 16.7% GH insufficiencies. 11.9% of patients had panhypopituitarism, 31.5% hyperprolactinemia. Lesion location: 37.8% intrasellar with extrasellar extention, 35.6% exclusively suprasellar, 26.7% intrasellar. 80.9% of patients were submitted to surgical treatment, 52.6% of those to transcranial approach. Nine patients submitted to radiotherapy and seven reoperated. Major surgical complications: CSF leakage (seven patients) and III pair injury (six patients). After treatment, headache improved in 66.7%. Visual complaints improved in 13%, persisted in 43.5% and worsened in 39.1%. Post-operatory analytical study showed worsening of hormonal deficits (panhypopituitarism in 26.3%, hypogonadism and hypothyroidism in 52.6%, GH and adrenal insufficiencies in 44.7 and 42.1% respectively). 47.4% maintained residual tumor, 21.1% relapsed. There were no deaths, 42 patients maintain follow-up.

Conclusion: Parasellar lesions represent a very heterogeneous group. In this series, where craniopharyngiomas were excluded, meningiomas and Rathke’s cleft cyst were the most frequent lesions. They originate variable clinical presentation and some degree of hormonal dysfunction. Surgical treatment leads to clinical improvement but worsening of hormonal dysfunction.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.