Ved R, et al. - Researchers conducted this study to evaluate clinical presentation, radiological appearances, and clinical outcomes in a cohort of patients with pituitary xanthogranulomas. Higher prevalence of pituitary xanthogranulomas was revealed during this study. In all cases, surgery restored normal vision. However, 4 patients (67%) required long-term hormonal replacement post-operatively. Potential indicators included imaging features such peripheral rim enhancement, a suprasellar tumour epicentre, and the absence of both calcification or cavernous sinus invasion. These indicators would assist the clinicians in alerting them to the possibility of pituitary xanthogranuloma during the evaluation of patients with cystic sellar and parasellar tumours.

Methods

• From May 2011-December 2016, the researchers screened a prospectively maintained pituitary surgery database for histologically confirmed pituitary xanthogranulomas.
• Then, retrospective case note assessments were performed by 3 independent reviewers.
• Patient demographics, clinical presentations, imaging, and clinical outcomes were examined.

Results

• The researchers performed 295 endoscopic endonasal pituitary surgeries during the study period.
• They identified pituitary xanthogranulomas (2%) in 6 patients.
• Visual field deficits and/or endocrine dysfunction were the most common presentation among patients.
• A cystic consistency, hyperintensity on T1-weighted MR images and contrast enhancement either peripherally (n = 3) or homogenously (n = 3) were identified as common imaging features.
• Hyperprolactinaemia and hypoadrenalism were the most common pre-operative endocrine deficits (at least 1 of which was identified in 4/6 patients; 66%).
• Diabetes insipidus was noted in 33% (2/6) patients.
• Adrenocortical dysfunction (66%) and gonadotropin deficiency (66%) were the most common post-operative endocrinological deficits.
• Normalised visual assessments were noted in all 6 patients post-operatively.
• Gross total resection was achieved in all patients.
• No cases of tumour recurrence were reported at median follow up of 33.5 months.