• Mass effect on adjacent structures (Fig. 11.1a and b). Tumors usually compress the optic nerves and chiasm, but occasionally they compress the third nerve, particularly in apoplexy [3] (Fig. 11.2). They may also very occasionally cause hydrocephalus by blocking CSF outflow in the third ventricle.

• Headache. This may possibly occur as a result of compression or stretching of the dural lining of the sella or of the diaphragmata, which are innervated by branches of the trigeminal nerve. It is this sudden stimulus that is believed to cause the pain of pituitary apoplexy, which may be so severe as to mimic sub-arachnoid hemorrhage.

• Incidental finding. Tumors may be found during investigation for some other condition. They are now officially known as the "incidentalomas".

Endocrine and visual symptoms are the most common forms of presentation, with headache and incidentalomas being infrequent.

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