Summary

Pituitary adenomas are by far the most common tumours of the sellar region, comprising 90 to 95% of all such tumours. Meningiomas, craniopharyngiomas(particu-larly in children), Rathke's cleft cysts and aneurysms are the most likely differential diagnoses. The majority of pituitary tumours are asymptomatic, discovered as "inciden-talomas" in the course of investigation for other conditions. The rest, along with other sellar lesions, present with symptoms of endocrine dysfunction, mass effect on surrounding structures, commonly the optic nerves or chiasm, or headache. Apart from Prolactin secreting tumours, which respond to dopamine agonists, the mainstay of treatment is surgery, with or without radiotherapy. Prior to surgery, even as an emergency, all sellar tumour patients should have thyroid function tests, Prolactin levels and adequate imaging. Any patient with a tumour with suprasellar extension should undergo formal visual field assessment. MRI scanning is the imaging modality of choice, with a CT scan for sphenoid septal anatomy if a transphenoidal approach is to be undertaken.

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