Pituitary macroadenoma (huge prolactinoma)

Case contributed by A.Prof Frank Gaillard

Presentation

Visual problems.

Patient Data

Age: 30
Gender: Female
Modality: MRI

A large pituitary region mass is present filling and enlarged fossa and extending above it. It severely displaces and compresses the right optic nerve (which appears medially displaced), and the chiasm. Posteriorly the tumour extends along the planum sphenoidale and floor of the anterior cranial fossa on the right, posteriorly bulges into the interpeduncular cistern. The tumour extends into the anterior sylvian fissure is apposed to the anterior surface of the M1 segment. Medially it encases the A1 segment and terminal ICA. The tumour bulges into the medial aspect of the right cavernous sinus without, somewhat surprisingly, definite evidence of invasion. Similar appearance is present on the left. Within the mass are numerous areas of non-enhancement, presumably representing cystic degeneration/necrosis the largest of which measures 2 cm in diameter.

The remainder of the imaged brain (please note this study has been targeted to the pituitary, and as such the whole brain has not been imaged) appears unremarkable.

Case Discussion

This patient had  known prolactinoma medically treated. This followup scan showed dramatic increase in the size of the mass, with a matching rise in prolactin. (Prolactin 77995 mIU/L)

Female prolactin reference ranges:

  • Non Pregnant 60-620 mIU/L
  • Pregnant 200-4420 mIU/L
  • Post-Menopausal 40-430 mIU/L
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Case Information

rID: 28182
Case created: 13th Mar 2014
Last edited: 4th Sep 2016
Inclusion in quiz mode: Included

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