Pituitary microadenoma - importance of dynamic contrast enhanced imaging
Infertility with raised serum prolactin
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Conventional imaging shows contour deformity of the left side of pituitary with minor heterogeneity in enhancement and minor stalk deviation to the right - indicative of a left sided tumour. It is only on the inital phase of the dynamic series that we see the true limits of tumour due to differential enhancement of the pituitary gland ie rapid compared with the tumour ie slow. Over time the density of both becomes equal ie washout of the pituitary and "filling in" of the tumour.
It is essential when reviewing cases with "increased prolactin" that one obtain the actual level, as stalk effect (interruption of the tonic inhibition of dopamine on prolactin release) can moderately increase the level without a secreting adenoma being present.