3 x MRI pituitary gland cases. 1st : normal pituitary gland | Figure 1

MRI Pituitary Gland Cases

1st Case

Normal pituitary gland (green arrows) with normal pituitary stalk (red arrows) in middle-aged male. Note the concave upper border of gland on coronal and the small white dot in gland posteriorly on the sagittal view—this is the normal posterior hypophysis (neurohypophysis). Note also the position of optic chiasm superiorly (yellow arrows).

2nd Case

Misread as a macroadenoma of pituitary in 23-year-old female, mainly because of "bulky appearance" and convex upper border—no change on yearly follow-ups. Note also the central vertical vascular tuft (purple arrows). This size and shape is normal in young females, especially during puberty and pregnancy. Upper limit of normal cranio-causal diameter of gland considered to be 8mm in males, 9mm in females, and up to 12mm in pregnancy.

3rd Case

Macroadenoma in 60-year-old male with visual disturbances. Note the "snowman" appearance of enlarged upward bulging gland—obviously enlarged. The optic chiasm is displaced upwards and draped over the gland—hence the visual disturbances. Also note how the pituitary gland is displaced and compressed upwards and to the left, draped over the mass (white arrows). The brightish appearance of the gland on the pre-Contrast study is probably a portion of the neurohypophysis and a larger portion of gland enhances and is seen draped on the post-Contrast series.

Case Highlights

Patient X’s Presentation

Patient X presented to the clinic with complaints of new onset diplopia associated with mild dizziness and a mild headache concentrated over the right eye. Patient X is a 19-year-old American female of Asian descent. Patient has no prior medical health conditions to date and denies any recent head trauma or illness. Patient admitted to starting new oral contraceptive 4 days prior to the onset of symptoms.

Pertinent Exam Findings:

• New onset small deviation right esotropia and hypotropia.
• No afferent pupillary defect noted.
• Versions were full in all positions of gaze.
• Visual field study was negative for clinically significant reduction in either eye.
• Anterior and posterior ocular segments were within normal range.
• IOPs were 19mmhg OD and OS.

Patient was immediately referred to the local emergency department for full neurological workup to rule out life-threatening etiologies. ER performed extensive blood work, MRI w/ and w/o contrast, MRA, and MRV. Reports from ER physician indicated a small non-specific mass approximately 4.0mm by 4.0mm on the dorsal pituitary gland. No other abnormality was mentioned. Patient was instructed to discontinue oral contraceptive use and is awaiting neuro-ophthalmology consult.

Radiographic Findings

1. Lateral radiographs of the skull allow visualization of superficial and deep landmarks concurrently:

   • Identify the coronal suture, which separates the frontal and parietal bones of the skull.
   • The lambdoid suture is visible posteriorly, dividing the parietal from the occipital bones.
   • Note that pneumatized bones, such as the maxilla (containing maxillary sinus), frontal bone (containing frontal sinus), sphenoid bone (containing sphenoid sinus), and mastoid process (containing mastoid air cells), appear radiolucent, or darker, than surrounding areas of the skull.
   • Superior to the sphenoid sinus, the bony sella turcica houses the pituitary gland.
   • The cervical spine is also apparent, with the anterior arch of atlas (C1) and dens of axis (C2) clearly delineated.

   Source: Atlas of Human Anatomy, 7th edition. ISBN: 9780323393225. Copyright ©2019 Elsevier, Inc.

Image References

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