Table 1 Previous reports of sellar involvement in GPA
1st Author & year | PMID | No. of cases | Age at GPA diagnosis | Age at time of sellar involvement | Sex | Pituitary Imaging (MRI unless stated) | Endocrinological abnormalities | Non-CNS features | ANCA |
|---|---|---|---|---|---|---|---|---|---|
Haynes 1978 [29] | 692550 | 1 | 26* | 25 | M | NA | DI Hyperprolactinaemia Normal TSH Normal LH & FSH | Lung, renal | N/A |
Hurst 1983 [30] | 6625709 | 1 | 47* | 47 | F | CT normal | DI Normal prolactin Normal TSH Post-menopausal LH/FSH | Polyarthritis, ENT, ocular, mucocutaneous, pulmonary | N/A |
Lohr 1988 [31] | 3172100 | 1 | 19* | 19 | F | Intrasellar mass | N/A | ENT, pulmonary | N/A |
Rosete 1991 [32] | 1865428 | 1 | 51* | 51 | F | CT: pituitary enlargement | DI | N/A | N/A |
Czarnecki 1995 [33] | 7611087 | 1 | 31 | 34 | F | Sellar mass with suprasellar extension. Enhancement of the stalk and hypothalamus. Loss of PS. | DI Hyperprolactinaemia | ENT, arthralgia | N/A |
Roberts 1995 [34] | 7758239 | 2 | 71* | 71 | F | Intrasellar mass with suprasellar extension | DI (post-surgery) ↓ TSH ↓ LH & FSH ↓ cortisol Normal prolactin | None | cANCA +ve |
28* | 28 | F | Intrasellar mass with low-density centre | DI (post-surgery) Normal prolactin Normal TSH Normal LH & FSH Normal cortisol | Ocular, arthralgia, cutaneous, renal | cANCA +ve | |||
Bertken 1997 [35] | 9265867 | 1 | 36* | 36 | F | Macrocystic pituitary mass with suprasellar extension. Hydrocephalus | DI (post surgery) ↓ TSH response ↓ LH & FSH responses | ENT, pulmonary, ocular | ANCA -ve |
Hajj-Ali 1999 [36] | 10461488 | 1 | N/A | 21 | F | Normal | DI | N/A | N/A |
Katzman 1999 [21] | 10219422 | 2 | 41* | 41 | F | Pituitary enlargement. Loss of PS | DI Hyperprolactinaemia Normal TSH Normal LH & FSH | Constitutional, arthralgia, ENT, ocular, cutaneous | cANCA +ve |
18* | 18 | F | Pituitary enlargement with contrast-enhancement. Loss of PS | DI Hyperprolactinaemia Normal TSH Normal LH & FSH | ENT, pulmonary | cANCA +ve | |||
Miesen 1999 [37] | 10069203 | 1 | 46* | 45 | M | Stalk thickening, contrast-enhancement. Loss of PS | DI Hyperprolactinaemia Hypogonadism Normal TSH Normal LH & FSH Normal cortisol & ACTH | ENT, renal, pulmonary | ANCA +ve |
Goyal 2000 [38] | 11003280 | 1 | N/A (many years before pituitary involvement) | 48 | F | Sellar mass with suprasellar extension. Contrast-enhancement | DI ↓ TSH | Renal, pulmonary | cANCA +ve |
Tappouni 2000 [39] | 11096156 | 1 | 58* | 57 | F | Pituitary mass | DI | Constitutional, ENT, cutaneous, renal, pulmonary | PR3 +ve |
Woywodt 2000 [40] | 11028850 | 1 | 30* | 30 | M | N/A (diagnosed at autopsy) | N/A | N/A | N/A |
Garovic 2001 [41] | 11136194 | 1 | 47* | 47 | F | Cystic enlargement of the pituitary. Non-enhancing with gadolinium | DI ↓ prolactin ↓ TSH ↓ gonadotropins | Constitutional, cutaneous, pulmonary | cANCA +ve |
Tao 2003 [42] | 14642162 | 1 | N/A | 19 | F | Pituitary and stalk enlargement with heterogenous enhancement | DI ↓ TSH Hypogonadism | N/A | N/A |
Muir 2004 [43] | 15150009 | 1 | 13* | 13 | M | Diffuse pituitary enlargement. Foci of ↑ T1 signal. More extensive ↑ T2 signal. Central contrast-enhancement. Loss of PS. | DI | ENT, pulmonary | ANCA +ve |
Vittaz 2004 [44] | 15687906 | 2 | 45 | 47 | M | Pituitary mass, with contrast-enhancement. Pituitary stalk thickened & infiltrated. Loss of PS | Hyperprolactinaemia ↓ testosterone ↓ LH, normal FSH ↓ cortisol & ACTH Normal TSH | Constitutional, polyarthritis, peripheral neuropathy, pulmonary | PR3 +ve |
46 | 50 | F | Pituitary enlargement | DI Hyperprolactinaemia Hypogonadism | Polyarthritis, ocular, mucocutaneous, ENT | ANCA +ve | |||
Duzgun 2005 [45] | 15864593 | 1 | 47* | 47 | F | Loss of PS | DI Anterior pituitary hormones normal | Polyarthritis, pulmonary, ENT, renal | PR3 +ve |
Seror 2006 [16] | 16523054 | 3 | 45 | 50 | F | Nodular pituitary enlargement. Homogenous contrast-enhancement. Loss of PS | DI Hyperprolactinaemia Thyrotropic deficiency Hypogonadism Corticotropic deficiency | ENT, ocular, mucocutaneous | PR3 +ve |
26 | 41 | F | Nodular pituitary enlargement. Contrast- enhancement | DI Normal anterior pituitary hormones | ENT, arthralgia, ocular, renal | PR3 +ve | |||
55 | 57 | M | Pituitary enlargement & central necrosis. Heterogenous enhancement. | DI Hyperprolactinaemia Panhypopituitarism | Peripheral neuropathy, pulmonary, retinal vasculitis, digital, cerebral and renal infarcts | PR3 +ve | |||
Spisek 2006 [46] | 16322901 | 1 | 30* | 29 | M | Sellar cystic lesion | DI ↓ TSH ↓ LH & FSH ↓ ACTH ↓ IGF-1 | ENT | PR3 +ve |
McIntyre 2007 [47] | 17318440 | 1 | 22* | 22 | F | Heterogeneous enhancing pituitary mass | DI Hypogonadism | Cutaneous, ocular, renal | PR3 +ve |
Thiryayi 2007 [48] | 17188492 | 1 | 21* | 21 | F | Sellar mass with central hypo-intensity | DI (post-surgery) Hypogonadism (post-surgery) | Constitutional, arthralgia | cANCA +ve |
Yong 2008 [49] | 17492510 | 1 | 33* | 33 | M | Pituitary stalk thickening. Contrast-enhancing nodule at the superior aspect of the stalk. Loss of PS. | DI Hypogonadism ↓ ACTH Normal prolactin Normal TSH Normal IGF-1 | ENT | PR3 +ve |
Cunnington 2009 [50] | 20107566 | 3 | 19 | 24 | M | Pituitary enlargement | DI Anterior pituitary hormones normal | Constitutional, ENT, pulmonary, ocular, cutaneous | PR3 +ve |
33 | 34 | F | Diffusely enlarged gland containing a poorly enhancing lesion with supra-sellar extension. Loss of PS. | DI Normal prolactin Normal TSH | Constitutional, ENT | cANCA+ve | |||
26 | 35 | M | Diffusely enlarged pituitary and thickened stalk. | DI ↓ TSH | Constitutional, ENT, pulmonary | cANCA +ve | |||
Xue 2009 [51] | 19172275 | 1 | 63* | 63 | F | Normal | DI TSH normal LH & FSH normal | Constitutional, pulmonary, peripheral neuropathy | PR3 +ve |
Barlas 2011 [52] | 21116602 | 1 | 35 | 37 | F | Anterior enlargement. Central area with low signal on T1 and high signal on T2. Post contrast enhancement of pituitary and stalk. Loss of PS. | DI Hyperprolactinaemia | ENT, pulmonary, polyarthritis | cANCA +ve |
Santoro 2011 [53] | 22147097 | 1 | 53* | 53 | F | Hypointensity of adenohypophysis on T1. Hyperintense sectors on R side on T2. Peripheral contrast-enhancement. Stalk-thickening. Loss of PS. | DI ↓ TSH Hypogonadism Normal prolactin | Polyarthritis, cutaneous, pulmonary, renal | cANCA +ve |
Tenorio- Jimenez 2011 [54] | 22673710 | 1 | 23 | 38 | F | MRI: marked infundibular thickening, sellar mass with hypointensity on T1. Loss of PS | Hyperprolactinaemia ↓ TSH Hypogonadism Post pituitary hormones unaffected | ENT, pulmonary, renal | cANCA +ve (−ve by the time of sellar manifestations) |
Hughes 2013 [55] | 23186961 | 1 | N/A | 30 | F | Sellar mass | Panhypopituitarism | Ocular | N/A |
Pereira 2013 [56] | 22898089 | 1 | 48* | 48 | F | Appearances of pituitary microadenoma, but histopathlogy revealed necrotizing granulomatous inflammation | Hyperprolactinaemia ↓ TSH Post pituitary hormones unaffected | ENT | N/A |
Kapoor 2014 [20] | 25077899 | 8 | N/A | 67 | F | Peripherally enhancing cystic sellar mass compressing the stalk | Hyperprolactinaemia Hypogonadism Normal TSH | ENT, renal | 7/8 cases PR3 +ve |
N/A | 48 | F | Multiple non-enhancing cystic areas in the pituitary, convexity of superior margin of pituitary | DI ↓ prolactin ↓ TSH Hypogonadism Corticotropic deficiency | ENT, pulmonary, cutaneous | ||||
N/A | 28 | F | Sellar mass with large zone of central non-enhancement and peripheral enhancement. Stalk displacement | DI Hypogonadism Normal prolactin Normal TSH Normal IGF-1 Normal cortisol | ENT, pulmonary, renal | ||||
N/A | 55 | M | Sellar mass with suprasellar extension | DI Hypogonadism Normal prolactin Normal TSH Normal cortisol Normal IGF-1 | ENT, pulmonary, renal, cutaneous, joints | ||||
N/A | 35 | M | Necrotic sellar mass with peripheral enhancement & suprasellar extension. Thickened contrast-enhancing stalk | DI ↓ TSH Hypogonadism Normal prolactin Normal cortisol Normal IGF-1 | ENT | ||||
N/A | 54 | M | Enlarged pituitary measuring 12 mm, with heterogeneous enhancement. Slight diffuse thickening of the stalk | DI ↓ TSH Hypogonadism Normal prolactin Normal IGF-1 | ENT, pulmonary, renal, cardiac | ||||
N/A | 68 | M | Homogeneously enhancing sellar mass, extending into the cavernous sinus bilaterally. Stalk preserved. | ↓ prolactin ↓ TSH Hypogonadism ↓ IGF-1 | ENT, joints | ||||
N/A | 28 | F | Sellar mass extending into the suprasellar cistern, with low T2 signal in the periphery and a bright centre. Peripheral enhancement with central cystic change. Thickening of pituitary stalk | DI Normal prolactin Normal TSH Normal cortisol Normal IGF-1 | ENT | ||||
De Parisot 2015 [19] | 25906106 | 9 | 46* | 46 | F | Enlarged posterior pituitary. Infiltration of posterior pituitary. Loss of PS | DI | ENT, ocular | |
60 | 70 | M | Normal | ↓ TSH Hypogonadism ↓ IGF-1 Normal prolactin | ENT, peripheral neuropathy | ||||
23 | 24 | F | Enlarged pituitary. Irregularity of infundibulum. Heterogeneous enhancement of anterior pituitary. Loss of PS | DI ↓ TSH Hypogonadism Normal prolactin Normal IGF-1 | ENT | ||||
24* | 24 | M | Enlarged infundibulum | DI Hyperprolactinaemia ↓ TSH Hypogonadism Normal IGF-1 | Renal, ocular, joints, gastro-intestinal | ||||
66 | 77 | M | Enlarged pituitary. Stalk infiltration. Loss of PS. | ↓ TSH Hypogonadism ↓ IGF-1 Normal prolactin | None | ||||
67 | 68 | F | Normal | DI Hyperprolactinaemia Normal TSH Normal LH & FSH Normal IGF-1 | ENT | ||||
28 | 42 | F | Heterogeneous enhancement of pituitary | DI Hyperprolactinaemia Hypogonadism ↓ ACTH | ENT, lung | ||||
55 | 57 | M | Sellar mass, heterogeneous. Enhancement. Enlargement and infiltration of stalk. Loss of PS | DI Hyperprolactinaemia ↓ TSH Hypogonadism ↓ ACTH | Pulmonary | ||||
46 | 50 | F | Enlargement and infiltration of pituitary. Heterogeneous enhancement, contact with optic chiasm | DI Hyperprolactinaemia Hypogonadism Normal TSH Normal IGF-1 | ENT, ocular | ||||
Eli 2016 [22] | 27521731 | 1 | 32* | 29 | F | Homogenously enhancing sellar mass. Thickened stalk. | Hyperprolactinaemia | ENT, pulmonary | MPO +ve |
Esposito 2017 [57] | 28540625 | 3 | 37* | 37 | F | Sellar mass extending into the suprasellar cistern with peripheral enhancement and central cystic lesion. Stalk deviation. | DI Hypogonadism GH deficiency | Constitutional, ENT | PR3 +ve |
36* | 36 | F | Cystic pituitary mass | DI Anterior pituitary function normal | Constitutional, myalgia, ENT, pulmonary | PR3 +ve | |||
32* | 32 | F | Sellar mass with homogeneous. Thickening of the pituitary stalk | DI Anterior pituitary function normal | ENT | PR3 +ve |