Case 295 -- An Intrasellar Lesion

Contributed by Volkmar H.J. Hans MD1, Horst Urbach MD2, Rudolf A. Kristof MD3, Martina Deckert MD1
  1Institute for Neuropathology, 2Division of Neuroradiology and 3Department of Neurosurgery, University Hospital, Bonn, Germany
Published on line in January 2002


A 59-year-old woman presented with a three-year history of right-frontal headache and fatigue. A cystic follicular adenoma of the thyroid had been resected 13 years before and a right frontal meningothelial meningioma (WHO Grade I) 17 months before. Neurological examination was unremarkable. GH response upon GHRH stimulation was reduced (GH basal 4.2 ng/ml, stimulated 7.2 ng/ml). The other pituitary and organotropic hormones showed physiological serum concentrations.

MRI studies disclosed an intrasellar non contrast-enhancing lesion 0.8 cm in diameter in a right paramedian location, lifting the sellar diaphragm and displacing the normal pituitary gland to the left. The signal intensity was like cortical gray matter on the T1-weighted MRI scans (Fig. 1). Coronal images of T1-weighted (TR 30ms, TE 7.6ms) MRI scans of the sellar region before (2A) and after Gd-DTPA enhancement (2B).

The patient underwent an uncomplicated transsphenoidal resection of a firm tumor that was readily separated from surrounding adeno- and neurohypophysis.



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