Pituitary prolactinoma - medically treated

Case contributed by Assoc Prof Frank Gaillard

Presentation

Headache. CT showed pituitary region abnormality. Otherwise healthy.

Patient Data

Age: 25 years
Gender: Female

The pituitary fossa contains a nodule which markedly compresses the remnant pituitary gland to the left side. This nodule contains a small peripheral cystic area inferiorly. On the dynamic sequence, delayed homogeneous enhancement is seen.

There is minor encroachment on the suprasellar cistern with no impingement on the optic nerves or the chiasm. On the left side, the rounded pituitary gland just encroaches into the cavernous sinus. There is no mass effect on the carotid vessels.

At diagnosis, the patient, who is not pregnant, had elevated prolactin levels and were commenced on medical management (cabergoline). 

Prolactin level

  • Prolactin 4877 mIU/L

Reference range:

  • Non-pregnant 60-620 mIU/L
  • Pregnant 200-4420 mIU/L
  • Post-menopausal 40-430 mIU/L
MRI

3 months of medical therapy

The sharply defined, slowly enhancing right-sided pituitary nodule has decreased in size compared to the earlier scan (3 months ago). The superior surface of the pituitary gland is no longer convex superiorly. The hypophyseal stalk is now displaced only slightly from right to left.

Dynamic scans show early poor opacification of the treated microadenoma. More delayed scans demonstrate increased signal intensity within the treated pituitary gland, compared with the normal territory gland.

Conclusion: Evidence of significant response to treatment, with shrinkage of right-sided pituitary microadenoma.

MRI

2 years of medical therapy

Appearances are unaltered. A small amount of hypoenhancing soft tissue located to the right side of the pituitary gland is again demonstrated, unaltered when compared to previous imaging. It is best seen on dynamic contrast enhanced imaging. 

MRI

4 years after diagnosis

A region of hypoenhancement remains present on the right side of the gland best appreciated on dynamic postcontrast sequences. There is no increase in size since the prior study. The lesion minimally displaces the infundibulum to the left of midline and normal enhancing pituitary tissue is placed within the left sided pituitary fossa.

MRI

8 years after diagnosis

The previously demonstrated hypoenhancing right pituitary lesion has decreased slightly in size. The pituitary stalk remains deviated to the left. No cavernous sinus extension identified. No compression or displacement of the optic chiasm identified. 

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Case information

rID: 75256
Published: 3rd Apr 2020
Last edited: 3rd Apr 2020
Inclusion in quiz mode: Included

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