Pituitary macroadenoma

Case contributed by Dr Mostafa El-Feky

Presentation

Bilateral diminished vision for one year, hyperprolactinemia, early menopause 5 years ago.

Patient Data

Age: 35 years
Gender: Female
MRI

MRI brain and sella

Enlarged pituitary gland measuring 2.7 x 2.7 x 3.6 cm in AP, SS and CC dimensions with widening of sellar floor showing solid homogeneous iso- to low signal intensity on T1 and T2, iso-intensity on FLAIR with homogeneous diffusion restriction. It shows mild heterogeneous enhancement. It is surrounded by peripheral thin enhancing rim notably posterior, mostly representing stretched pituitary tissue forming pseudo-capsule.

Superiorly, it mainly grows upwards giving snowman appearance obliterating suprasellar cistern, elevating and compressing the optic chiasm. Smooth outline of the lesion with no invasive behavior. Laterally, mildly displacing both internal carotid arteries with partial encasement yet no narrowing nor invasion to the cavernous sinuses. Inferiorly, widening of the sellar floor with intact clivus showing homogeneous marrow signal. Posteriorly, indenting tuber cinereum and the distal end of the basilar artery.

Case Discussion

Radiological features are of large non-invasive large sellar and suprasellar lesion with classical "snowman appearance" appearance along with the clinical picture of hyperprolactinemia, diminished vision, and early menopause are in-keeping with a pituitary macroadenoma.

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Case information

rID: 64261
Published: 13th Nov 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: Dar El Ashaa Center

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