Bilateral diminished vision for one year, hyperprolactinemia, early menopause 5 years ago.
MRI brain and sella
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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.