Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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September 21, 2009
Nonsecretory Pituitary Macroadenoma
- Pituitary adenomas are almost always benign; no malignant potential. Pituitary macroadenomas (> 10 mm) are usually nonsecretory and present with symptoms of mass effect (mainly on optic chiasm) or invasion of adjacent structures instead of related specific hormone production.
- MR is best modality of imaging for pituitary adenomas, allowing characterization of morphology and signal intensity, demarcation of tumor boundaries, assessment of cavernous sinus, sphenoid sinus and/or clivus invasion and demonstration of mass effect on neighboring structures. Underlying bone destruction and tumoral calcification can be seen and are better demonstrated with CT.
- Differential diagnosis of relatively common suprasellar masses: suprasellar extension of pituitary adenoma, sarcoid, metastasis, meningioma, teratoma (and other germ cell tumors), craniopharyngioma, hypothalamic glioma or hamartoma, optic glioma and aneurysm. Neoplasms in the sellar region, including clivus, may also have superior extension and should be considered (chordoma, chondrosarcoma, metastasis).
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