The pituitary gland lies in the pituitary fossa (sella turcica), which is situated in the middle cranial fossa at the base of the brain. It is linked functionally to the hypothalamus by the pituitary stalk. The hypothalamus lies in a superior position to the pituitary gland, and the link between the 2 organs is critical for normal pituitary gland function.
The anterior pituitary secretes growth hormone (GH), thyrotropin or thyroid-stimulating hormone (TSH), corticotropin or adrenocorticotropic hormone (ACTH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin. The posterior lobe secretes arginine vasopressin (also called antidiuretic hormone) and oxytocin.
Pituitary masses may be classified based on their underlying etiology: for example, pituitary adenoma, pituitary hyperplasia, nonadenoma tumors, and vascular, inflammatory, or infective lesions. Most pituitary masses are caused by a pituitary adenoma; these may be classified as microadenomas (<10 mm) or macroadenomas (>10 mm).[1]Arafah BM, Nasrallah MP. Pituitary tumors: pathophysiology, clinical manifestations and management. Endocr Relat Cancer. 2001 Dec;8(4):287-305.
http://erc.endocrinology-journals.org/content/8/4/287.long
http://www.ncbi.nlm.nih.gov/pubmed/11733226?tool=bestpractice.com
[2]Molitch ME. Diagnosis and treatment of pituitary adenomas: a review. JAMA. 2017;317:516-524.
http://www.ncbi.nlm.nih.gov/pubmed/28170483?tool=bestpractice.com
Pituitary masses may present with a typical clinical syndrome resulting from hypersecretion of ≥1 anterior pituitary hormones (e.g., Cushing disease, acromegaly). Alternatively, they may present more insidiously with mass effect or with tumor expansion leading to compression of surrounding structures, including normal pituitary tissue, resulting in hypopituitarism. Functional pituitary tumors can produce a complex picture of combined hormonal excess and/or deficiencies.[1]Arafah BM, Nasrallah MP. Pituitary tumors: pathophysiology, clinical manifestations and management. Endocr Relat Cancer. 2001 Dec;8(4):287-305.
http://erc.endocrinology-journals.org/content/8/4/287.long
http://www.ncbi.nlm.nih.gov/pubmed/11733226?tool=bestpractice.com
Pituitary masses may also be found incidentally on autopsy and on imaging with a prevalence ranging from 0.10% to 0.38%, with a mean prevalence of 22.3%.[1]Arafah BM, Nasrallah MP. Pituitary tumors: pathophysiology, clinical manifestations and management. Endocr Relat Cancer. 2001 Dec;8(4):287-305.
http://erc.endocrinology-journals.org/content/8/4/287.long
http://www.ncbi.nlm.nih.gov/pubmed/11733226?tool=bestpractice.com
[3]Daly AF, Tichomirowa MA, Beckers A. The epidemiology and genetics of pituitary adenomas. Best Pract Res Clin Endocrinol Metab. 2009;23:543-554.
http://www.ncbi.nlm.nih.gov/pubmed/19945022?tool=bestpractice.com
A combined analysis of both radiologic and autopsy data yielded a final prevalence rate of incidental pituitary adenomas of 16.7%.[3]Daly AF, Tichomirowa MA, Beckers A. The epidemiology and genetics of pituitary adenomas. Best Pract Res Clin Endocrinol Metab. 2009;23:543-554.
http://www.ncbi.nlm.nih.gov/pubmed/19945022?tool=bestpractice.com
Almost all of these are clinically silent microadenomas. The prevalence increases with age, and detection is more likely using high-resolution MRI sequences.[4]Morris Z, Whiteley WN, Longstreth WT Jr, et al. Incidental findings on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ. 2009;339:b3016.
http://www.bmj.com/content/339/bmj.b3016.full
http://www.ncbi.nlm.nih.gov/pubmed/19687093?tool=bestpractice.com
