Presentation
Hyperprolactinemia, pre-menstrual mastalgia and blurring of vision. The prolactin level is 200 ng/mL
Patient Data
The right cavernous sinus is the seat of an avidly enhancing mass lesion that is seen filling the sinus cavity.
It has the following relations and extensions:
medially; it is seen indenting, uplifting and displacing the pituitary gland with contralateral shift of the pituitary stalk
laterally, it is seen reaching the lateral wall of the sinus and abutting the medial aspect of the right temporal lobe; this would indicate encasement of the intra-cavernous cranial nerves
The lesion is seen also seen completely encasing the cavernous segment of the right ICA, which appears slightly attenuated, yet it preserves its signal void pattern denoting patency.
There is an enhancing dural tail along the inferior medial surface of the right temporal lobe.
Case Discussion
Hyperprolactinemia due to mass effect on the pituitary stalk (stalk effect) is usually mild 30-200 ng/mL, while in case of pituitary microadenoma, the serum prolactin level is usually above 1000 ng/mL