Presentation
Incidental finding on CT.
Patient Data
On sagittal imaging, the anterior pituitary appears bulky as does the infundibulum due to it abutting the optic chiasm.
There is symmetric tortuosity of the cavernous internal carotid arteries compressing the anterior pituitary gland and displacing part of it superiorly abutting the optic chiasm. The infundibulum is midline and there is normal homogeneous contrast enhancement of the pituitary. No abnormal restricted diffusion in the brain.
Conclusion:
Tortuosity of the cavernous ICAs result in distortion of the pituitary gland and account for the apparent prominence of the gland on CT.
Case Discussion
If one only looks at the midline sagittal of this case, then it definitely looks abnormal. In this age group, you would expect the pituitary to be deflated, sitting at the bottom of the pituitary fossa.
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