title: Clinical and Anatomic Features of Supraglandular Pituitary Adenomas.
abstract: OBJECTIVE
  Supraglandular pituitary adenoma (SGPA) is one of the extraordinary pituitary adenomas and shows different clinical and radiologic features. We retrospectively reviewed our cases of SGPAs to elucidate the radiologic, anatomic, and clinical features.
  
  
  METHODS
  We identified 9 patients with pathologically proven SGPA and classified them into 2 groups radiologically: either glandular or stalk types. Magnetic resonance images were correlated with intraoperative anatomic differences between the groups. Clinical and endocrinologic characteristics and surgical outcomes were reviewed.
  
  
  RESULTS
  The proportion of SGPAs was 1.2% of all pituitary adenomas surgically treated in our patient cohort. The glandular-type tumors (n = 7) had a thinned or defective diaphragma sellae. There was a clear plane between the tumor and pituitary stalk. For the stalk-type tumors (n = 2), the diaphragma sellae was intact and no clear border between the mass and stalk was found. Endocrinologic and immunohistochemical evaluation showed that 5 of 7 glandular-type tumors (71%) were functioning pituitary adenomas, whereas 2 stalk-type tumors were nonfunctioning. Eight of 9 patients underwent an endoscopic endonasal approach and tumor was totally removed in 7 (78%).
  
  
  CONCLUSIONS
  SGPAs are rare and preoperative diagnosis is possible based on their distinct radiologic, clinical, and anatomic features. SGPAs can be divided into 2 groups according to the anatomic features. The origin of tumor, whether the superior surface of the gland or the pituitary stalk, determined the location, extent, and relationship with the diaphragma sellae. The surgical outcome via an endoscopic endonasal approach was favorable.
authors.affiliation: Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea; Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Phi
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: kimyh96@snu.ac.kr.
authors.forename: Yong Hwy
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Jung Hee
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Dong Gyu
authors.initials: DG
authors.lastname: Kim
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D004724:Endoscopy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010902:Pituitary Gland / Q000000981:diagnostic imaging; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D012658:Sella Turcica / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: Endonasal; Endoscopy; Pituitary adenoma; Supraglandular