Pituitary prolactinoma - medically treated

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.

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.

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. 

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.

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.