title: Clinical problem solving: monster on the hook--case problems in neurosurgery.
abstract: OBJECTIVE
  Nonfunctioning and functioning pituitary tumors can present in numerous ways. They may be difficult to diagnose correctly and, even with proper treatment, may lead to complications.
  
  
  METHODS
  We present the case of a patient who presented with a large, invasive sellar mass and underwent both medical and surgical treatment for this lesion. The patient's course did not progress as was expected from his initial workup.
  
  
  RESULTS
  The patient's history, physical examination, laboratory values, pathologic specimens, and radiologic findings are discussed. His management before, during, and after medical therapy and surgery is reviewed by pituitary experts from 2 different institutions. Aspects of diagnosis and management of sellar lesions are presented and reviewed in the literature.
  
  
  CONCLUSIONS
  Neurosurgeons frequently treat patients with sellar lesions and should remember that despite modern laboratory, pathologic, and radiologic techniques, the diagnosis and treatment of these lesions is not always clear.
authors.affiliation: Department of Neurological Surgery, Emory University Hospital, Atlanta, Georgia 30322, USA. Carrie.Muh@choa.org
authors.forename: Carrie R
authors.initials: CR
authors.lastname: Muh
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Boulis
authors.forename: William F
authors.initials: WF
authors.lastname: Chandler
authors.forename: Ariel L
authors.initials: AL
authors.lastname: Barkan
authors.forename: Marina B
authors.initials: MB
authors.lastname: Mosunjac
authors.forename: Nelson M
authors.initials: NM
authors.lastname: Oyesiku
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness; D010911:Pituitary Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D015175:Prolactinoma / Q000175:diagnosis* / Q000601:surgery*; D012658:Sella Turcica / Q000473:pathology / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome