Pituitary hypertrophy in pregnancy

Case contributed by A.Prof Frank Gaillard

Presentation

Pregnant. Unsure of history otherwise.

Patient Data

Age: 30 years
Gender: Female

MRI (pregnant)

Modality: MRI

Non-contrast MRI has been performed (the patient is pregnant). The anterior pituitary is plump, upwardly convex, extending into the suprasellar cistern and just contacting the chiasm. Cavernous sinuses are normal in appearance. 

Conclusion: Features are those of normal physiological enlargement of the pituitary during pregnancy. 

MRI 14 months later (not pregnant)

Modality: MRI

The size of the pituitary has decreased to within normal limits. The upward convexity contacting the chiasm is no longer present. Normal appearances of the chiasm and cavernous sinuses. No lesion identified on dynamic postcontrast imaging, but on the sagittal post contrast scans, there is a 1mm slit of non-enhancement in the region of pars intermedia most likely to represent a tiny pars intermedia/Rathke's cleft cyst.

Conclusion: Previous enlargement of the pituitary is in keeping with normal physiological enlargement which has normalised postpartum.

MRI 15 months later (pregnant again)

Modality: MRI

Non-contrast MRI has been performed (the patient is pregnant once more). The anterior pituitary is again plump, upwardly convex, extending into the suprasellar cistern and just contacting the chiasm. Cavernous sinuses are normal in appearance. 

Conclusion: Features are those of normal physiological enlargement of the pituitary during pregnancy. This appears identical to the first pregnancy. 

Case Discussion

It is important to recognise that the pituitary enlarges substantially during pregnancy. Failure to be aware of this, can result in an incorrect diagnosis of a macroadenoma. 

In this instance, such a concern was voiced on the original scan (performed at another institution) and thus resulted in the followup studies. 

PlayAdd to Share

Case Information

rID: 50503
Case created: 8th Jan 2017
Last edited: 9th Jan 2017
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.