Pituitary macroadenoma with intratumoral haemorrhage
Sudden onset of headache, hypothyrodism, low TSH and visual defect.
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Sagittal T1 images demonstrate a heterogenous sella mass with suprasellar extension leading to impression of the optic chiasm and infundibular recess of the third ventricle. Areas of high T1 signal are seen in the superior portion of the mass which may represent haemorrhage/methaemoglobin. This area of high signal intensity fails to supress on the coronal T1 FS. Coronal and axial T2 images confirm intralesional haemorrhage with peripheral haemosiderin staining and a central region of mixed signal intensity representing different stages of blood product degredation. The mass demonstrates a peripheral and nodular pattern of enhancement. Presella pneumatisation of the sphenoid sinus. Overall imaging pattern is most in keeping with pituitary macroadenoma with intratumoral haemorrhage.
Pituitary apoplexy is characterised by clinical presentation of headache, visual disturbance and endocrine disturbane. Ischaemia and haemorrhage of a pre-existing macroadenoma is the most common cause of pituitary apoplexy.