Presentation
Headaches and visual disturbances
Patient Data
MRI demonstrates a large homogenously enhancing pituitary fossa mass measuring 4.19 x 4.17 x 3.50 cm (CC x AP x Transverse) in its largest dimensions that completely replaces and expands the sella and extends into the suprasellar region. The AP and transverse measurements stated are for the suprasellar component of the mass which is the largest. The suprasellar component of the mass exhibits increased T1 signal and blooming artifact on the GRE sequences strongly suggestive of hemorrhage. It is causing compression of the optic chiasm and also contacts the intracranial segments of the optic nerves bilaterally. It abuts and encases the cavernous (C3), clinoid (C4) and ophthalmic (C5) segments of bilateral internal carotid arteries but does not invade them. It is also abutting and pushing the A1 segments of bilateral anterior cerebral arteries superiorly without any invasion. There is no restricted diffusion or associated hydrocephalus.
Diagnosis: Pituitary macroadenoma with suprasellar extension and apoplexy.
Case Discussion
Pituitary adenomas are the most common tumors of the sella. Majority are seen in adults. When greater than 1 cm they are referred to as macroadenomas. Macroadenomas are typically slow growing causing enlargement and remodeling of the sella. They can be heterogenous due to bleeding, cystic change or necrosis.
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