Intrasphenoidal pituitary macroadenoma
Infertility with elevated serum prolactin found on routine investigation. No visual symptoms.
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Highly unusual finding of an intra-sphenoidal mass contiguous with the floor of the sella. The pituitary is otherwise of normal shape with an upward concavity and mid-line stalk with only minimal deviation to the left. This is almost a true ectopic pituitary adenoma, however, there is a probable subtle connection with the gland via the left lateral aspect where there is a minor contour bulge and slightly reduced enhancement equal to that of the sphenoidal mass.
Intrasphenoidal extension of pituitary tumour is well recognised but usually seen in large tumours that erode the floor and enter the sinus. In this case, there is minimal intra-parenchymal tumour with the major portion of the mass located within the sinus. On that basis this is not a true ectopic pituitary tumour that can occur usually in concert with an empty sella. The other possible diagnosis in this case is a sphenoidal sinus tumour eroding into the sella, however, the elevated prolactin mitigates against this diagnosis in a young patient.
It would be critical to assess the actual level of prolactin as slight elevation is not uncommon. CT bone of the sphenoid would also be very useful.