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38-Year-Old with Decreased Vision
This case features a 38-year-old patient presenting with decreased vision, ultimately diagnosed with a pituitary macroadenoma (PitNET).
Imaging overview:
Sagittal T1, coronal T2 fat-saturated, and coronal T1 post-contrast fat-saturated MRI images demonstrate a large sellar and suprasellar mass with a characteristic “snowman” shape, replacing the native pituitary gland. Post-contrast imaging confirms avid enhancement of the lesion, with superior extension toward the optic chiasm corresponding to the patient’s visual complaints.
Clinical insight:
Pituitary macroadenomas (PitNETs) are neuroendocrine tumors of the pituitary gland, classified as macro when greater than 1 cm in size. Their characteristic snowman configuration on imaging reflects suprasellar extension beyond the sella turcica. Patients frequently present with visual complaints due to compression of the optic nerve or chiasm. Classification schemes used in reporting include Knosp for cavernous sinus involvement, Zurich for predicting gross total resection, and SIPAP for describing growth directions. When reporting these cases, careful attention to cavernous sinus extension is essential, as these tumors represent the most common indication for endoscopic sellar access.
Case courtesy of Remy Lobo, MD
University of Michigan
University of Utah