Pituitary hyperplasia

Case contributed by Dr Bruno Di Muzio

Presentation

Pregnant woman in her 38 gestational week presenting with a 2 week history of visual disturbance (right temporal superior quadrantanopia). TSH 1.83 ,lu/L, fT4 4.0 pmol/L; fT3 2.7 pmol/L; prolactin 8252 mlU/L.

Patient Data

Age: 30-year-old
Gender: Female
MRI

MRI Pituitary (non-contrast)

The pituitary gland is enlarged and demonstrates avid homogeneous contrast enhancement. The gland extends into the suprasellar cistern and elevates/compressed the optic chiasm. The pituitary stalk is midline and appears normal. No cavernous sinus invasion. No convincing remodelling of the sella.

MRI

MRI Pituitary (after delivery)

The pituitary gland is enlarged. This has marginally reduced in CC dimension since the previous study, however the AP and trans dimensions are unchanged. It demonstrates avid homogeneous contrast enhancement. The gland extends into the suprasellar cistern and elevates/compressed the optic chiasm. The pituitary stalk is midline and appears normal. No cavernous sinus invasion. No convincing remodelling of the sella.

MRI

MRI Pituitary (5 months later)

There has been further reduction in size of the pituitary gland,. The entire pituitary gland enhances homogeneously, with no differential focus of enhancement seen within the pituitary gland. The infundibulum remains midline. The optic chiasm is contacted but not displaced.

Case Discussion

Pituitary hypophysitis is divided into:

  • lymphocytic: is the most common form and  has an autoimmune pathogenesis. It is frequently observed in women during their late pregnancy or in the early postpartum period
  • granulomatous: pathogenesis remains uncertain and does not have the epidemiology related to women and pregnancy

On imaging, they present as symmetric and homogeneous pituitary enlargement, with vivid and homogenous enhancement, usually enlarging the stalk. It has been described that hypophysitis also shows loss of the posterior pituitary bright spot due to the autoimmune involvement 1

Adenomas, on the other hand, are typically asymmetric and show a heterogeneous enhancement due to its cystic or necrotic areas.

This case was assumed to be a hyperplastic pituitary gland related to the pregnancy and was confirmed to improve in a few months after the delivery. The patient had normal hormones values at the time of the last scan. 

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Case information

rID: 45623
Case created: 1st Jun 2016
Last edited: 26th Jun 2016
Tag: rmh
Inclusion in quiz mode: Included

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