Pituitary mass with a fluid-fluid level

Discussion:

Although distinguishing between a cystic/necrotic pituitary adenoma and a Rathke's cleft cyst can be challenging the presence of a fluid-fluid level is quite specific for the diagnosis of an adenoma (specificity, 96.4%). This is in contrast to an intracystic dot which favors a Rathke's cleft cyst.

Importantly, elevated prolactin is not necessarily due to secretion of prolactin, rather a mass that compresses the pituitary stalk can lead to interruption of dopamine flow from the hypothalamus through the hypophyseal-portal circulation to the anterior pituitary. Unlike other hypothalamic control of the pituitary, control of prolactin secretion is primarily inhibitory. See causes of elevated prolactin.

Unfortunately, in this instance, no followup is available.

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