Endocrine Manifestations of Intracranial Extrasellar Lesions

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Abstract
Fourteen patients with intracranial extrasellar lesions simulating primary pituitary disease are presented. Two had aneurysms of the internal carotid artery, 4 had tumors involving the third ventricle, 4 had internal hydrocephalus due to a block in the aqueduct of Sylvius, and 1 each had glioma of the optic chiasm, arteriovenous anomaly of the left cerebrum, meningioma of the floor of the anterior fossa and mucocele of the sphenoid sinus. Thirteen patients had clinical and laboratory evidences of hypothalamic-hypophysial dysfunction. Abnormality of gonadotropin secretion occurred in 10, of TSH secretion in 6, of ACTH secretion in 5, and 4 had diabetes insipidus. All the patients with third-ventricle tumors, glioma of the optic chiasm and arteriovenous anomaly and one of those with aneurysm of the internal carotid artery had the most extensive endocrine deficiencies. In several cases, substitution therapy with cortisone was crucial in carrying the patients through stressful experiences, and in their rehabilitation. The importance of adequate endocrine substitution therapy in the management of these patients is emphasized. In the 4 patients with internal hydrocephalus, the onset of the illness had been in childhood; they were characterized by delayed pubescence in 3 and precocious puberty with delayed menarche in the fourth. The patients with aneurysm of the internal carotid artery, internal hydrocephalus, meningioma and mucocele of the sphenoid sinus demonstrated x-ray changes in the skull suggesting pituitary tumor, whereas the other patients were characterized by prominent endocrine manifestations without significant alterations in the sella turcica.