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                \\\\\___ M E D I C A L   L I N K S ___\"-._
                /////~~~ internetaction@yahoo.com  ~~~/.-'
           
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         The Endocrinologist - Volume 13, Number 1, February 2003
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                              ABSTRACT
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              "The pituitary stalk and hypothalamus are 
                 susceptible to involvement by cystic, 
          neoplastic, infectious, and inflammatory processes".
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The clinical features, diagnostic approach, and management
of these lesions are reviewed. 
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Patients may seek treatment for symptoms of anterior or posterior 
pituitary dysfunction, hyperpro-lactinemia, visual and neurologic 
symptoms because of mass effect, or hypothalamic impairment. 
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The diagnostic evaluation includes assessment of pituitary and stalk 
function, magnetic resonance (M-R) imaging, investigation for potential 
systemic disease, and, if necessary, pathologic examination. 
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Imaging usually discloses a suprasellar or parasellar location, and 
certain specific etiologies may be suspected based on typical (M-R) 
features.
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Although lesions involving the pituitary stalk and hypothalamus can 
present at any age, cystic lesions and most primary neuronal tumors are 
more typically seen in children; meningiomas and infectious and 
inflammatory processes are more common in young adults; and metastatic
malignancy must be considered in older patients. 
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In many cases management of stalk and hypothalamic masses is surgical. 
However, isolated, non-progressive lesions such as intrasellar Rathke’s
cleft cysts or lymphocytic hypophysitis may be managed medically;
and specific therapy for lesions associated with systemic diseases
may be indicated before surgical consideration.

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                  (The Endocrinologist 2003;13: 38*51)
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Learning Objectives:
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* Contrast various treatment options for craniopharyngioma and other 
cystic lesions of the pituitary stalk and hypothalamus.
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* Summarize the best surgical or alternative approaches
to treating primary tumors in this region.
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* Identify alternatives to surgery for treating inflammatory
disorders of this region.
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* Distinguish the advantages of medical and surgical
treatment measures when systemic disorders involve
the pituitary stalk or hypothalamus.
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Mass lesions involving the hypothalamic-pituitary system
are becoming an increasingly common diagnostic
challenge for endocrinologists, particularly since the introduction
of magnetic resonance (M-R) imaging. 
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This article will focus on those lesions that involve primarily the 
hypothalamus and pituitary stalk, highlighting the clinical, 
bio-chemical,and radiographic features that distinguish them
from the more common primary pituitary adenomas. 
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For each type of lesion, a management approach based on published
findings and the authors’ experience will be presented.
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The anatomy and blood supply of the hypothalamus
and pituitary gland renders it susceptible to involvement
by central nervous system (CNS) lesions, and from a number
of systemic disorders.
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These lesions generally include primary CNS tumors, cysts, metastases, 
and infiltration by inflammatory or infectious processes. 
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Patients may seek treatment for symptoms and signs caused by local
mass effect, hormonal alterations, or with an asymptomatic
abnormality on brain imaging.
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       SIGNS AND SYMPTOMS OF HYPOTHALAMIC AND PITUITARY STALK LESIONS
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The clinical features of lesions involving the hypothalamus
and pituitary stalk depend on their location, their degree
of adjacent extension, and their rate of progression. 
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For example, slow-growing masses tend to cause less tissue destruction
and symptoms caused by compensatory processes.
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                        ~Lorraine~Lipscombe,MD~

*Fellow, Division of Endocrinology and Metabolism, Department of
Medicine, University of Toronto, Toronto, Ontario, Canada.
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                          ~Sylvia~Asa,MD~

*Professor and Pathologist-in-Chief, Department of Pathology, 
University Health Network, University of Toronto, Toronto, Ontario, 
Canada.
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                          ~Shereen~Ezzat,MD~

*Professor and Director, Endocrine Oncology, Mount Sinai Hospital,
University of Toronto, Toronto, Ontario, Canada.
_____________________________________________________________________________

Address correspondence and reprint requests to: ~Shereen~Ezzat~
M.D., 600 University Avenue, Suite 437, Mount Sinai Hospital, Toronto,
Ontario M5G 1X5 Canada. 
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Telephone: 416 586-8505; Fax: 416 586-8834 
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E-mail: sezzat@mtsinai.on.ca
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The authors have disclosed that they have no significant relationship
with or financial interest in any commercial company pertaining to this
educational activity.
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