Diagnostic Approach to Sellar/Suprasellar Masses Causing Bitemporal Hemianopsia

Primary Diagnostic Considerations

The American College of Radiology recommends MRI of the brain with and without contrast using thin-section pituitary protocol as the gold standard imaging modality for evaluating sellar/suprasellar masses presenting with bitemporal hemianopsia 1, 2
Craniopharyngiomas are critical to distinguish from pituitary adenomas, as they demonstrate characteristic calcification on CT imaging that may not be readily apparent on MRI alone, according to the Journal of the American College of Radiology 1, 5
CT of the head is complementary to MRI for detecting calcification patterns, as suggested by the Journal of the American College of Radiology 1

Comprehensive ophthalmologic evaluation, including visual acuity and visual field testing, should be obtained, as recommended by the Nature Reviews Endocrinology and Praxis Medical Insights 3, 4, 2
Complete hormonal screening, including thyroid function tests, morning cortisol and ACTH, prolactin, sex hormones, and growth hormone/IGF-1, should be performed, as suggested by Praxis Medical Insights 2, 6
High-resolution MRI of the brain with and without IV contrast is the preferred initial imaging modality, providing detailed visualization of the pituitary gland and optic chiasm, according to the Journal of the American College of Radiology and Praxis Medical Insights 1, 2, 6

Transsphenoidal resection is the mainstay of treatment for most sellar tumors, except prolactinomas, with complete resection being the treatment of choice when feasible, as recommended by Praxis Medical Insights 2, 6
Lifelong endocrine surveillance is mandatory following treatment, as hormonal deficiencies may develop or progress over time, even after successful resection, according to Praxis Medical Insights 2, 6

Obtaining histopathological assessment, including immunostaining for pituitary hormones and Ki-67, is crucial for accurately classifying the neoplasm, as suggested by the Nature Reviews Endocrinology and Praxis Medical Insights 7, 6
Ki-67 ≥3% combined with local invasion on imaging predicts 25% recurrence rate in pediatric cases, according to the Nature Reviews Endocrinology and Praxis Medical Insights 7, 6