title: Clinical predictors of advanced sellar masses.
abstract: OBJECTIVE
  To identify clinical variables associated with the presence of a structurally advanced sellar mass (ASM).
  
  
  METHODS
  We performed a retrospective study of patients referred for evaluation of suspected new pituitary disease or sellar mass to the Endocrine Oncology Unit of Mount Sinai Hospital in Toronto, Ontario, Canada. By multivariate analysis, we examined predictors of a structurally ASM (a sellar lesion with any of the following characteristics: diameter of >or=1 cm on magnetic resonance imaging [MRI], optic chiasmal compression on MRI, or clinical or biochemical evidence of hypopituitarism).
  
  
  RESULTS
  Data from 152 patients were analyzed. Of the 152 sellar masses, 142 (93%) were pituitary adenomas. An ASM was noted in 85 of the 152 patients (56%). In the final multivariate model, male sex (odds ratio [OR], 6.23; 95% confidence interval [CI], 2.84 to 13.56; P<0.001) and self-reported visual field defect (OR, 3.62; 95% CI, 1.07 to 12.25; P = 0.039) were significantly independently associated with the presence of an ASM. The presence of new or changed headaches also tended to be associated with an ASM (OR, 2.11; 95% CI, 0.96 to 4.64; P = 0.063). Age and self-reported galactorrhea were not independently associated with the presence of an ASM and were conditionally removed from the final model.
  
  
  CONCLUSIONS
  In patients with suspected sellar or pituitary disease, male sex and self-reported visual field defects independently predict the presence of an ASM. New or changed headaches also tend to be related to the presence of an ASM. The presence of predictors of an ASM should prompt expedited sellar MRI and biochemical evaluation.
authors.affiliation: Department of Medicine, York Central Hospital, Richmond Hill, Ontario, Canada.
authors.forename: Gloria M
authors.initials: GM
authors.lastname: Rambaldini
authors.forename: Sonia
authors.initials: S
authors.lastname: Butalia
authors.forename: Shereen
authors.initials: S
authors.lastname: Ezzat
authors.forename: Walter
authors.initials: W
authors.lastname: Kucharczyk
authors.forename: Anna M
authors.initials: AM
authors.lastname: Sawka
mesh_terms: D000236:Adenoma / Q000150:complications / Q000175:diagnosis*; D000328:Adult; D016001:Confidence Intervals; D003937:Diagnosis, Differential; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009864:Ontario; D010911:Pituitary Neoplasms / Q000150:complications / Q000175:diagnosis*; D012189:Retrospective Studies; D012658:Sella Turcica / Q000473:pathology*