Complaint : 40Y,
Headache from 3 months & visual disturbance from 1
MRI Brain T1 & T2 Wt. Images of Axial, Coronal & Sagittal sections.
3.0 cm well defined smooth marginated
iso intense lesion on T1 and slightly hyper intense lesion with
fluid fluid levels which are hyper intense on T1 and
mixed intense on T2 noted in the sella and supra sellar
regions. Lesion is figure of eight in the coronal sections &
displacing abutting the optic chiasm Sell is widened.
Pituitary macro adenoma with hemorrhage and abutting the optic
Differential Diagnosis :
females 18-35 years have upwardly convex pituitary
Usually <10 mm
unless pregnant, lactating
Can occur with
end-organ failure (e.g. ovarian, thyroid)
female or young male has "adenoma-looking" pituitary, do endocrine
eccentric, not directly suprasellar
visible, identified separate from mass
common on MR
common (rare in adenoma)
Meningioma (diaphragma sellae)
visible, can be identified separate from mass
sellae identifiable as thin, dark line between mass (above) and
pituitary gland (below)
thickening more extensive than with adenoma
base invasion by adenoma may mimic more ominous disease
can see systemic metastases to stalk, pituitary gland.
adenoma clinically, on imaging studies
Most common in
adenomas extend inferiorly, invade sphenoid, may destroy upper
=> 4 cm in diameter. Prolactin levels are often > 1000 ng/ml
No matter how
aggressive/invasive adenoma looks, Pituitary tumors are almost never
REFERENCE : Osborn, Diagnostic Imaging,
Brain 1st edition, 2004.
BY: Academic division, 'MA' Advanced Diagnostic & Research Centre,
Guntur, AP. INDIA.
DR. M.ADINARAYANA RAO. MD.
DR. G.GOWRI SEKHAR . DNB.,DMRD.
DR. D. PRASAD REDDY. DMRD.
DR. Ch.SIVARAMA KRISHNA. DM(Neurology)