Pituitary adenomas are benign monoclonal tumors that arise from one of the five anterior pituitary cell types and may cause clinical effects from either overproduction of a pituitary hormone or compressive/destructive effects on surrounding structures, including the hypothalamus, pituitary, optic chiasm, and cavernous sinus. About one-third of all adenomas are clinically nonfunctioning and produce no distinct clinical hypersecretory syndrome. They are typically identified because of mass effects or as incidental findings during imaging for other reasons. Among hormonally functioning neoplasms, tumors secreting PRL are the most common (∼50%); they have a greater prevalence in women than in men. GH- and ACTH-secreting tumors each account for about 10–15% of functioning pituitary tumors. Adenomas are classified as microadenomas (<10 mm) or macroadenomas (≥10 mm). Pituitary adenomas (especially PRL- and GH-producing tumors) may be part of genetic familial syndromes such as MEN 1, Carney syndrome, or mutant aryl hydrocarbon receptor inhibitor protein (AIP) syndrome. Other entities that can present as a sellar mass include craniopharyngiomas, Rathke’s cleft cysts, sella chordomas, meningiomas, pituitary metastases, gliomas, and granulomatous disease (e.g., histiocytosis X, sarcoidosis).

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