The Sella and

Parasellar Region

John R. Hesselink, M.D.

Department of Radiology

University of California

San Diego

Adenohypophysis

Hormones: Prolactin, Gonadotropin

Somatotropin (growth hormone)

Adrenocorticotropin (ACTH)

Thyroid stimulating hormone (TSH)

Follicle stimulating hormone (FSH)

Luteinizing hormone (LH)

Hypothalamus produces releasing factors

Portal-hypophysial system between

median eminence and anterior lobe

Anatomy & Function

Pituitary

Gland

Neurohypophysis

Hormones:

Vasopressin (ADH) & Oxytocin

Produced in supraoptic

& paraventricular nuclei

Transported via axonal flow

Stored in neurosecretory granules

Anatomy & Function

Pituitary Gland

Posterior Lobe

The Normal Pituitary Gland

Gland height 8 mm

Size normally increases in adolescent

females & during pregnancy

Gland parenchyma relatively homogeneous

Signal intensity on T1W images

Anterior lobe = isointense

Posterior lobe = hyperintense

Gland, stalk & median eminence enhance

<

Normal

Pituitary

Gland

Coronal

Plane

Normal Pituitary Gland

Sagittal Plane - Gadolinium

Normal Newborn Pituitary Gland

71

Pituitary Gland

T1W SE coronal Gadolinium injection

T1W SE coronal T1W SE sagittal

Pulse Sequences

Note: Use overlapped 3 mm sections, 512/256 matrix,

18 cm FOV, 2/4 NEX. Include T2W FSE for hypothalamic

lesions. For post-op sella, use fat suppression with Gd.

Pituitary Pathology

Abnormalities of size or position

Pituitary adenoma

Other rare tumors

Diabetes insipidus

Lymphocytic hypophysitis

Pituitary Gland

Benign pituitary hyperplasia

Pituitary hypoplasia

The empty sella

Ectopic pituitary

Sheehan's syndrome

Abnormalities of Size & Position

Intrasellar Position

of the Carotid Artery

L 15

History: 26 y.o. female presents with small

stature and panhypopituitarism

140

Dx: Small gland,

absent stalk &

ectopic bright spot

{Page 2}

395

Partially

Empty Sella

Ectopic Posterior Pituitary

L 4

Sheehan’s Syndrome

Pituitary Adenoma

Arise within the adenohypophysis

Nonsecreting adenomas cause mass effect

Bitemporal hemianopsia

Secreting adenomas cause endocrine syndrome

Prolactinemia

Acromegaly, Giantism

Cushing's disease

Hyperprolactinemia

Physiologic Pregnancy

Nursing

Nipple

stimulation

Sexual

intercourse

Exercise

Sleep

Stress

Pathologic

Prolactinoma

Hypothalamic

tumors

Chronic renal

failure

Cirrhosis

Intercostal nerve

stimulation

Pharmacologic

Hypoglycemia

Hyperaminoacidemia

Hormone: estrogen, TRH

Dopaminergic Antagonists

Catecholamine

inhibitors/depleters

Serotonin precursors

GABA agonists

Histamine H2 antagonists

Opiates

Microadenoma

History: 26 y.o. female with headaches

and blurred vision

83

1 2

Dx: Microadenoma

{Page 2}

6

5

4

3

Dx: Prolactinoma

History: 45 y/o woman with

headaches & elevated prolactin

671

Dx: Pituitary hyperplasia

History: 38 y/o female

with anemia, hypothyroid,

increased TSH & prolactin

382

Cushing's Disease

L 33-5

ACTH Levels

Right petrosal vein = 34 ppm

Left petrosal vein = 866 ppm

History: 50 y/o woman

with headaches & visual changes

367

Dx: Pituitary macroadenoma

{Page 2}

Dx: Pituitary apoplexy

History: 24 y/o female

with a visual deficit

554

History: 35 y/o female with visual

loss & ophthalmoplegia

514

Dx: Prolactin = 7000

{Page 2}

Choristoma Myoblastoma, Granular cell tumor, Pituicytoma

163

History: 35 y/o

HIV+ male with

severe anemia

Dx: Meningioma

Anemia {Page 2}

Lymphocytic Hypophysitis

L 10-11

Dx: Brucellosis

pituitary abscess

History: 47 y.o. woman with

headache, fever & vomiting.

12

Suprasellar Pathology

Craniopharyngioma, Rathke's cleft cyst

Chiasmatic & hypothalamic gliomas

Hamartoma, Germinoma

Lymphoma

Arachnoid cyst, Epidermoid, Dermoid

Granulomatous disease

Perisellar Anatomy

A - Pituitary gland

B - Optic chiasm

C - Supraclinoid

carotid artery

D - 3rd nerve

E - Intracavernous

carotid artery

F - Ophthalmic nerve

G - Cavernous sinus

H - Sphenoid sinus

Craniopharyngioma

Arise from epithelial remnants

of Rathke's pouch

Suprasellar location

Benign but produce mass effect

Cysts & calcification common

Nodular enhancement

History: 74 y/o woman with frontal

headaches & light sensitivity

731

Dx: Papillary craniopharyngioma

{Page 2}

History: 53 y/o man with bitemporal hemianopia

271

{Page 2}

Dx: Craniopharyngioma

History: 63 y/o man with

hyponatremia & hypopituitarism

393

{Page 2}

Dx: Rathke's cleft cyst

Hypothalamic Glioma

F 74-6

Central Diabetes Insipidus

Trauma or surgery - 50% of cases

Idiopathic - 25% of cases

Craniopharyngioma

Hypothalamic glioma

Germinoma

Granulomatous disease

Etiology

Dx: Diabetes insipidus –

idiopathic vs lymphocytic

hypophysitis

History: 20 y/o male with polyuria

& polydypsia for 2 weeks

745 - 22855969

History: 23 y/o male

with epilepsy

571

Dx: Hamartoma – tuber cinereum

{Page 2}

Suprasellar Arachnoid Cyst

F 93-5

EL-7342

History: 57 y.o. man with blurred vision

Dx: Epidermoid cyst

{Page 2}

FS

FS

Suprasellar Pathology

Langerhan's cell histiocytosis

Sarcoidosis

Tuberculosis

Fungal infections

Granulomatous Disease

History: 54 y.o. man with headaches for 2

months & decreased mental status

{Page 2}

History: 44 y/o man

with chronic headaches

{Page 2}

Cavernous Sinus

& Parasellar Pathology

Meningioma

Nerve sheath tumors

Skull base tumors

Vascular lesions

Inflammatory disease

165

History: 83 y/o man

with decreasing vision

in the left eye

Dx: Cavernous sinus

meningioma

Decreasing vision

{Page 2}

History: 38 y/o male with

right facial numbness

657 - Telerad

Dx: Schwannoma

{Page 2}

History: 9 y.o. girl

with multiple bilateral

cranial nerve palsies

History: 35 y/o woman with right eye

pain and amenorrhea

370

{Page 2}

Eye pain

{Page 3}

Dx: Chondrosarcoma

History: 31 y/o female with recurrent

otitis, headache, and diplopia

694

Dx: Chordoma

{Page 2}

History: 80 y/o man

with hypertension

515

Dx: Cavernous aneurysm

{Page 2}

History: 46 y.o. man with a left 3rd nerve palsy

15

Dx: Septic thrombosis

of the left

cavernous sinus

{Page 2}