Intrasphenoidal pituitary macroadenoma

Case contributed by Dr Chris O'Donnell

Presentation

Infertility with elevated serum prolactin found on routine investigation. No visual symptoms.

Patient Data

Age: 20 years
Gender: Female
Modality: MRI

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.

Case Discussion

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. 

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Case Information

rID: 49886
Case created: 8th Dec 2016
Last edited: 6th Jan 2017
Inclusion in quiz mode: Included

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