HEMORRHAGIC PITUITARY MACROADENOMA: AN UNUSUAL MEDICAL EMERGENCY

1. HEMORRHAGIC PITUITARY MACROADENOMA:
AN UNUSUAL MEDICAL EMERGENCY
Dr Ruma Zaidi, Dr Narinder Kaur, Dr Devanshu Rohilla, Dr Debaditya Mitra
Department of Radiodiagnosis,
Government Medical College & Hospital, Chandigarh.

2. CLINICAL HISTORY
• 50 year old man was brought to medicine emergency with complaints of
sudden onset altered sensorium and vomiting since 2days.
• On examination, he was disoriented to time, place and person, with
Glasgow Coma Scale (GCS) of 9/15 at the time of admission.
• His initial laboratory test revealed hyponatremia (serum sodium
120mmol/L); he was started on i.v. 3% saline.
• Worsening altered sensorium and drop in GCS following saline infusion
necessitated magnetic resonance imaging (MRI) brain to rule out osmotic
demyelination syndrome.

3. T2WI sagittal (A), axial (B) and FLAIR coronal (C) images of brain shows a T2/FLAIR isointense lesion
occupying the sella and causing its widening with central T2/FLAIR hyperintensity showing fluid-fluid
level within (red arrow in A).
Superiorly it is extending into suprasellar cistern and interhemispheric fissure displacing the B/LACOM
arteries laterally (black arrowheads in B).
Laterally it is seen involving the right cavernous sinus (green arrow in C), however flow voids in B/L ICA
are maintained.
A B C

4. A B
Axial T2* image (A) shows blooming of the dependent layer of fluid-fluid level within
the aforementioned lesion (green arrow) indicating hemorrhage.
Axial DWI/ADC images (B) shows patchy diffusion restriction along the periphery of the
lesion.

5. Coronal T1WI pre (A) and post (B) contrast images show homogeneous peripheral enhancement of the
Sellar mass. Laterally it is seen to extend into B/L cavernous sinuses encasing the B/L ICA.

6. DIAGNOSIS & FOLLOW UP
A B C
• Diagnosis: Hemorrhagic pituitary macroadenoma (Knosp grade 4).
• Follow up: Patient underwent trans-sphenoidal hypophysectomy and the
diagnosis was confirmed on histopathological examination.