A 55-year-old male, underlying disease of HBV infection, presented with a history of dull-aching headache for 1 year.

MRI Brain T1 with Gadolinium result is as shown above.

Questions

1. Please describe the MRI brain findings

2. Please give differential diagnosis

3. What is the appropriate further management in this patient?

ANSWERs

1. MRI brain T1 with Gadolinium

• Seen enhanced magnetic resonance of a pituitary macroadenoma (size >10 mm) in the sella which extends superiorly to contact with the optic nerves
• Lateral extension to right cavernous sinus
• Absence of tumor lateral to the cavernous carotid artery
• Posterior pituitary bright spot is not visualized.

2. Differential diagnosis

• The differential of a pituitary macroadenoma is essentially the list of conditions leading to a pituitary region mass, including craniopharingioma, meningioma

3. Appropriate further management

• Laboratory tests include basal hormone levels and dynamic hormone measurements depending on the tumor studied.
• All tumors should undergo screening basal hormone measurements, which may include prolactin, IGF1, FT4, TSH, cortisol, LH, FSH, estradiol, testosterone, UA, electrolyte
• Vision tests:  because some pituitary tumors can press on nerves that lead from the eyes to the brain, causing vision problems

 
เรียบเรียงโดย พญ.ณฐ ตันติธรรม และ พญ.ปานรวี สุขวัฒก์ แพทย์ประจำบ้านชั้นปีที่ 2 กองอายุรกรรม รพ.ภูมิพลอดุลยเดช กรมแพทย์ทหารอากาศ