Presentation
Decreased libido.
Patient Data
An intrasellar mass in the right lateral aspect of the posterior portion of the anterior pituitary gland, it is relatively isointense on T1, hypointense on T2, and hypo enhancing as compared to the normal residual pituitary gland, with no cystic or hemorrhagic change. The mass almost completely encases the intra-cavernous segment of the right internal carotid artery (Knosp grade IV of cavernous sinus invasion); however, no significant carotid narrowing. The normal infundibulum and the pituitary gland deviate to the left.
The prolactin level was >470ng/ml.
The previously noted mass shows a noticeable interval size reduction, it appears relatively hypointense on T1, hyperintense on T2, and hypo enhancing as compared to the normal residual pituitary gland, with no cystic or hemorrhagic change.
In the second scan, the patient was on medical treatment with cabergoline, and the serum prolactin was reduced almost to half of the baseline level.
The previously noted mass lesion has almost completely vanished, the patient was still on medical treatment, and the serum prolactin level was reduced to 29 ng/ml with noticeable clinical improvement.
Case Discussion
Feature of right-sided pituitary adenomas /neuroendocrine tumor (PitNET), mostly lactotroph adenoma/macroprolactinoma based on the clinical context, with interval size reduction to almost vanishing indicating excellent response to medical treatment, however, the decision to safely withdraw the medication necessitate clinical and laboratory correlation.
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