Pituitary Tumors Differential Diagnoses

Updated: May 23, 2017
  • Author: Jorge C Kattah, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
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DDx

Diagnostic Considerations

A number of other intracranial neoplasms can present as intrasellar tumors. These include craniopharyngiomas, meningiomas, neurofibromas, ectopic germinomas, and, rarely, metastatic tumors.

Granulomatous and infectious disorders can localize to the sellar region or the hypothalamus (eg, sarcoid, tuberculomas).

Carotid artery aneurysm can occur in the intrasellar region.

Lesions in the sphenoid sinus, such as a mucocele, can mimic the clinical picture of a pituitary adenoma.

Hypothalamus compression can cause increased prolactin levels because of a decrease in the prolactin inhibitory factor. Thus, hyperprolactinemia may be seen with non–prolactin-secreting pituitary adenomas and other sellar lesions with hypothalamic compression.

An unusual postpartum lymphocytic inflammatory pituitary lesion can be associated a mass lesion. This is known as lymphocytic hypophysitis.

Acromegaly can result from a nonpituitary source of increased growth hormone.

Differentiating between Cushing disease and Cushing syndrome, which is related to adrenal hyperplasia or tumor, is important.

Other causes of hyperprolactinemia that are unrelated to mass lesions in the pituitary or the hypothalamus include the following:

  • Intracranial - Empty sella syndrome, pseudotumor cerebri, status post cranial irradiation
  • Pharmacological - Antipsychotics (and other dopamine receptor antagonists), methyldopa, reserpine, verapamil, estrogen, opiates, cimetidine, sulpiride
  • Endocrine - Primary hypothyroidism
  • Metabolic - Chronic renal failure, cirrhosis
  • Other unusual causes - Breast manipulation, chest wall lesions, spinal cord lesions, stress
  • In some cases, a specific cause cannot be established.

Differential Diagnoses