Sella and Suprasellar Brain Tumours and Infiltrarive Disorders Affecting the HPA-Axis

The pituitary is a unique organ that is key to maintaining end organ function. However, it is particularly susceptible to some tumors, cysts, and infiltrates. Disruption of pituitary function may help target symptom etiology, but can lead to significant morbidity and mortality if not treated effectively. Patients can present with similar symptom of mass effect, headaches, and pituitary deficiencies despite disparate types of lesions. In some cases, the patient is asymptomatic, and the lesion is found incidentally on Computerized Tomography (CT)/Magnetic resonance imaging (MRI) imaging. Treatment may depend on the type of lesion found on MRI or after surgical pathology when a definitive diagnosis is acquired. Disorders such as empty sella syndrome may be primary or secondary to other disorders such as intracranial hypertension or occur after tumor resection. Infiltrative and infective disorders may be primary or localized to the pituitary, or may result secondarily from other system diseases. Cysts or tumors beginning in embryonic development can become symptomatic, with growth impacting the optic apparatus resulting in mass effect symptoms such as headaches and/or visual changes. Other tumors may originate in the hypothalamus, grow downward and impact the optic apparatus and the pituitary gland. Assessment includes a detailed history and physical, MRI and biochemical and dynamic testing for pituitary dysfunction. MRI may have characteristics suggestive of a diagnosis but surgical pathology is often required for a definitive diagnosis. Treatment is often dictated by tumor or lesion histology. Nursing assessment includes patient emotional, social and executive functions, resources, family history including parental and personal exposures. Together these form the basis of patient education, preparation for further testing and treatment planning decisions. The patient’s family can be important historians of patient symptoms particularly in the event of cognitive and memory dysfunction.