Infiltrative lesions include neoplastic lesions discussed above; inflammatory lesions, which include sarcoidosis, xanthoma, lymphocytic and granulomatous hypophystis, and Wegner’s granulomatosis; vascular lesions, including aneurysms and apoplexy; and infectious lesions, such as tuberculosis or other infections or abscesses.115-117
This section focuses on pituitary apoplexy, a potentially life-threatening condition associated with sellar lesions. This rare endocrine emergency usually results from hypothalamic pituitary adrenal axis dysfunction and associated deficiencies in anterior pituitary hormone secretion. Patients usually present with headache, vomiting, altered sensorium, visual defect.
The exact incidence of pituitary apoplexy is difficult to estimate, as many cases remain undiagnosed. However, it could occur in up to 21% of non-functioning pituitary tumors. Pituitary apoplexy is often the first presentation of the underlying pituitary tumor in over 80% of patients. Most cases of pituitary apoplexy present in the 5th or 6th decade with a slight male preponderance ranging from 1.1 to 2.25:1.0.118
In a recent retrospective analysis of 42 pituitary apoplexy patients from 1980 to 2007, the sex ratio was 3:1 with median age of the patients of 53.5 (range 21–85) years.119 In the largest series from India studied at Vellore, the sex ratio was approximately 2:1 with mean age of presentation of 40.4 (range 18-65) years.120 A study by Liu et al. showed a slight female preponderance for combined clinical and subclinical cases, however amongst clinical cases it was more common in males.118,121