Evaluation of clinical and magnetic resonance imaging profile of pituitary macroadenoma: A prospective study

Abstract

Background:Pituitary macroadenoma is a common tumor of middle-aged people. Magnetic resonance imaging (MRI) is the investigation of choice for its evaluation. Various parameters regarding the extent, consistency, and contrast uptake can be studied and a noninvasive diagnosis is possible.Aims and Objectives:To study the MRI features and extent of pituitary macroadenomas.Materials and Methods:We studied clinical and MRI features of 33 patients of all age groups and both sexes with pituitary macroadenomas who presented to Dayanand Medical College and Hospital, Ludhiana from January 2014 to June 2015. MRI was carried out on MAGNETOM Avanto 18 Channel 1.5 Tesla Machine by Seimens India Ltd. The dedicated sellar protocol consisted of sagittal and coronal T1-weighted image (TI-WI) and T2-WI without intravenous contrast using thin slices (3 mm) and a field of view of <200 mm.Results:On analysis of the 33 cases, we observed that patients of pituitary macroadenoma showed an almost equal sex incidence and average age group of 50–60 years. The common presenting complaints were headache and decreased vision. Superior and inferior extent of the lesion was beyond the defined boundaries of sella in most cases, but the lateral extent was limited, resulting in characteristic “snowman-like” appearance. The imaging characteristics showed solid to predominantly solid consistency, appearing mostly heterogeneously hyperintense on T2-WI, and hypo to isointense on T1-WI with intense postcontrast enhancement. Hemorrhage is less common. Pituitary apoplexy is rare and can result in spontaneous resolution.Conclusions:We conclude that the knowledge of clinical and imaging profile of pituitary macroadenoma can help the radiologists to diagnose these sellar lesions, and hence their therapeutic approach can be defined timely.

Melanoma metastasis to a nonfunctioning pituitary macroadenoma: illustrative case

“…36 Macroadenomas most often appear heterogeneous and hyperintense on T2-weighted images and isointense on T1-weighted images. 37 These imaging findings were noted in our patient, further supporting the radiographic diagnosis of PA rather than metastatic melanoma initially. Although features such as hemorrhage and invasion into the cavernous sinus may help to distinguish a pituitary metastasis from an adenoma, these characteristics are not specific to metastasis.…”

“…38 Additionally, in a prospective study of patients with pituitary macroadenoma, almost half of patients (45.45%) were noted to have imaging features of intratumoral hemorrhage. 37 The level of variability in tumor presentations and imaging characteristics requires a final diagnosis to be made histopathologically.…”

Frequency of Pituitary Adenoma among the Patients with Chronic Headache

“…Gupta K. also reported that majority of macroadenoma's had supra sellar extension (72.7%). [29]. Limitation of our study was that number of patients was less.…”

Collision of Two Tumors: A Case Report of a Lung Adenocarcinoma With Metastasis to a Pituitary Adenoma

“… 6 Targeted radiotherapy to the pituitary gland, particularly stereotactic radiotherapy, is associated with a significant improvement in survival time (16 months) compared to that of untreated patients (6 months). 8 Nevertheless, unless effective targeted treatment is available for the primary malignancy, the prognosis is still poor, as survival is determined by the primary malignancy itself rather than the pituitary lesion.…”

“…In our case, differentiating a pituitary adenoma from a collision tumor based on imaging studies alone was challenging: intratumoral hemorrhage and loss of the posterior bright spot on pituitary MRI are also observed in pituitary adenomas and are not specific to pituitary metastases. 8,9 However, metastasis to the pituitary gland should be suspected in the presence of aggressive bony destruction, rapid growth with a relatively normal pituitary fossa, involvement of the infundibulum, the appearance of a dumbbell-shaped tumor with a clear indentation at the level of the diaphragma sellae, or the presence of additional intracerebral metastatic lesions. 10 The definitive diagnosis of collision tumors, therefore, is made through histopathologic examination of the sellar mass, mostly from tumors resected during pituitary surgery or rarely, from postmortem examination.…”