Sella/parasellar Flashcards
Sella/parasella - Aduts DDx (5)
Pituitary adenoma,
Pituitary apoplexy,
Rathke cleft cyst,
Epidermoid,
Craniopharyngioma
Pituitary adenoma (7)
Most common tumour of the sella, 97% in adults.
If greater than 1cm, they are microadenomas.
Most functional ones secrete prolactin, especially in women.
Symptoms are easy to pick up in women (menstrual irregularity, galactorrhoea).
Men tend to present later due to more vague (decreased libido).
On MR, 80% are T1 dark and T2 bright.
Take up contrast more slowly than normal brain parenchyma.
Pituitary adenomas - trivia (4)
Microadenoma under 10mm, macro is over 10mm
Microadenomas typically form in the adenohypophysis
Prolactinoma is the most common functional type.
Typically they enhance less than normal pituitary.
Pituitary apoplexy (6)
Haemorrhage or infarction of the pituitary, usually into an enlarged gland, either from pregnancy or macroadenoma.
Associated with:
- bromocriptine (or other prolactin drugs)
- Sheehan syndrome
Will be T1 bright (adenoma is usually T1 dark).
Lack of hormones can cause hypotension.
Rathke cleft cyst (3)
Usually incidental, rarely symptomatic.
They are variable on T1 and T2, but are usually bright on T2.
Do not enhance.
Craniopharyngioma (6)
2 types:
- papillary and adamantinomatous.
Papillary type is the adult type. Solid, with no calcifications.
Recur less frequently than adamantinomatous form (because they’re encapsulated).
Strongly enhance.
Relationship to the optic chiasm is key for surgery.
Sella/parasellar - paeds DDx (2)
Craniopharyngioma,
Hypothalamic Hamartoma
Craniopharyngioma (4)
Paeds type is adamantinous.
Calcified, unlike papillary type.
Recur more than papillary.
Buzzword is “machinery oil”
Hypothalamic hamartoma (4)
Hamartoma of the tuber cinereum (part of hypothalamus located between mamillary bodies and optic chiasm).
T1 and T2 isointense. do NOT enhance.
Classic Hx of Gelastic seizures (although precocious puberty is more common)
