Pituitary macroadenoma

Case contributed by Hoe Han Guan , 8 Feb 2023
Diagnosis almost certain
Changed by Hoe Han Guan , 8 Feb 2023
Disclosures - updated 14 Dec 2022: Nothing to disclose

Updates to Case Attributes

Status changed from draft to published (public).
Published At was set to .

Updates to Study Attributes

Findings was changed:

Well-circumscribed lobulated sellar mass (originated from the sella turcica as evidenced by upwards displacement of diaphragmatic leaflets, which they themselves constrict onto the mass forming the characteristic snowman configuratioN) causes expansion of sella turcica. It has suprasellar extension.The mass demonstrates isointensity on T1W and T2W (relative to grey matter) and homogeneous enhancement post gadolinium.No intralesional hyperintensity on T1W to suggest haemorrhagichemorrhagic component.Superiorly, it compresses onto the optic chiasm significantly as well as upward displacement floor of third ventricle. Obstruction of bilateral Foramen of Monro results in acute obstructive hydrocephalus with transependymal CSF seepage.Postero-inferiorly, the suprasellar mass exerts onto the midbrain with obliteration of interpeduncular cistern.Laterally, no extension into the bilateral cavernous sinuses without encasement of internal carotid arteries.

Normal pituitary gland and infundibulum are not well visualised.

Updates to Study Attributes

Findings was changed:

Annotated images show the importance of diaphragmaticdiaphragma sella/leaflets to guide radiologists the most likely origins of the sellar/suprasellar mass.If the diaphragmatic leaflets are pushed upwards by the sellar mass, the origin is from the sella turcica. If the diaphragmatic leaflets are pushed downwards by the suprasellar mass, the origin is from the suprasellar region (possible differential diagnoses include meningioma, aneurysm, craniopharyngioma).The constriction of the soft pituitary macroadenoma by the diaphragmatic leaflets formed the "snowman sign".

Modality changed from to Annotated image.

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