Fatma R. Izzati1, Dessika Rahmawati2, Donny W. Wardhana3, Wino V. Vrielia4, Laksmi Sasiarini5, Nyoman S. D. Yudha5, Iriana Maharani6, Aina Angelina7
1Department of Neurology, Faculty of Medicine, Brawijaya University, Malang, Indonesia;
2Neurooncology Division, Department of Neurology, Faculty of Medicine, Brawijaya University, Malang, Indonesia;
3Department of Neurosurgery, Faculty of Medicine, Brawijaya University, Malang, Indonesia;
4Department of Ophthalmology, Faculty of Medicine, Brawijaya University, Malang, Indonesia;
5Endocrinology Division, Department of Internal Medicine, Faculty of Medicine, Brawijaya University, Malang, Indonesia;
6Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Brawijaya University, Malang, Indonesia;
7Department of Anatomic Pathology, Faculty of Medicine, Brawijaya University, Malang, Indonesia
Correspondence to: Fatma R. Izzati, MD. Neurology Resident, Department of Neurology, Faculty of Medicine, Brawijaya University, Jl. Veteran, Malang 65145, East Java, Indonesia. Email: fatmaneuro@student.ub.ac.id.
Background: Due to their location, sellar region tumors can affect a patient’s quality of life by mass compression effect and disrupting pituitary function. The treatment choice is determined by some factors, including the presence of mass effect and whether the tumor is secreting or non-secreting. This study assessed the preoperative and postoperative clinical manifestation, hormonal, and head magnetic resonance imaging (MRI) profile of sellar region tumor in Dr. Saiful Anwar General Hospital, East Java.
Methods: This study used a descriptive, cross-sectional design. Data were taken from sellar region tumor registry of Dr. Saiful Anwar General Hospital from March 2023 to April 2024.
Results: Twenty-five patients were included in the study, with 18 (72%) women and 22 patients (88%) aged 41–60 years old. The most frequent neurological symptom was blurred vision (23 patients; 92%). Hormones checked were thyroid hormones [free T4 (FT4), T3, thyroid-stimulating hormone (TSH)], prolactin, cortisol, growth hormone, and gonadotropic hormone [testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH)], but not all patients were checked for all these hormones. Patients were further classified into having low, normal, or high level of the respective hormones, and patients mostly had normal levels. Pituitary macroadenoma was the frequently suspected tumor from head MRIs (11 patients; 44%). Eleven patients underwent tumor excision. Ten patients showed pituitary adenoma and one patient showed pituicytoma on histopathological examination. Mean levels of FT4, T3, and prolactin were decreased after surgery, but TSH and cortisol levels were increased. On postoperative head MRI, four patients showed reduced mass size and one patient showed no residual lesion.
Conclusions: While pituitary macroadenoma was suspected in most head MRIs in this study, most of them were likely non-secreting. Therefore, surgical approach remained the mainstay of treatment. The need for medical management for hormonal disturbances was minimal. While postoperative data were incomplete, some findings from our patients showed that surgical approach could indeed reduce mass effect by improving bitemporal hemianopsia and pituitary deficit.
Keywords: Sellar region tumor; clinical manifestation; hormonal feature; magnetic resonance imaging (MRI)
