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Endoscopic surgery for cystic lesions of the pituitary region

Nature Clinical Practice Endocrinology & Metabolism volume 4, pages 662–663 (2008)Cite this article

Cystic lesions of the pituitary gland and sella turcica are relatively common but pose a challenge in terms of diagnosis and treatment. Several kinds of cystic lesion are recognized. Each has a characteristic appearance on MRI and requires a specific treatment strategy.1,2,3,4 In this Viewpoint, I describe the clinical symptoms and diagnosis of these cystic lesions, and discuss the endoscopic approach to surgical intervention.

The most common cystic lesions encountered within the sella turcica are cystic pituitary adenomas. These lesions are occasionally related to subclinical pituitary apoplexy. They usually present as asymmetrical cysts of heterogeneous consistency, and are thought to derive from liquefied areas of necrosis or hemorrhage within a pituitary tumor. Cystic lesions can arise from any subtype of hormone-secreting pituitary adenoma. One of the hallmarks of cystic prolactin-secreting pituitary adenomas is their failure to shrink in response to medical therapy, which contrasts with the response seen with solid prolactin-secreting pituitary adenomas. Indeed, some clinicians believe that prolonged medical therapy for cystic pituitary adenomas might actually jeopardize surgical outcomes. Lesions associated with progressive visual loss respond well to surgical decompression, with prompt restoration of vision.2

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  1. Department of Neurosurgery, Brigham and Women's Hospital, 15 Francis Street, Boston, MA 02115, USA elaws@partners.org

Authors and Affiliations

  1. ER Laws is the Director of Pituitary Surgery in the Department of Neurosurgery at Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,

    Edward R Laws

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  1. Edward R Laws
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Laws, E. Endoscopic surgery for cystic lesions of the pituitary region. Nat Rev Endocrinol 4, 662–663 (2008). https://doi.org/10.1038/ncpendmet0975

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