Pituitary macroadenoma with apoplexy

Case contributed by Bahman Rasuli
Diagnosis almost certain


Worsening of headache and decreased visual acuity.

Patient Data

Age: 50 years
Gender: Female

Large sellar and suprasellar mass lesion measuring about 20*25*30 mm with heterogeneous texture showing areas of intrinsic hyperintense T1 signal particularly on the left side reflecting intratumoral hemorrhage.

The pituitary gland is not identified with the widening of the sellar floor which remains intact in keeping with the pituitary origin.

It is extending to the suprasellar cistern elevating and compressing the optic chiasm.

Also, laterally displacing both cavernous sinuses, with partial encasement of both internal carotid arteries.

High signal foci in T2 and flair sequences at subcortical and periventricular white matter of both cerebral hemispheres depict microvascular ischemic events.

Case Discussion

Regarding the above imaging findings, pituitary macroadenoma with intratumoral hemorrhage, also known as pituitary apoplexy is the main diagnosis. The patient had the diagnosis confirmed histologically after transsphenoidal resection. 

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