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case_images: Preoperative cranial magnetic resonance imaging (MRI) in (A) coronal and (B) sagittal views showed an enlarged pituitary gland, with a 1.3 cm x 1.3 cm x 1.4 cm enhancing suprasellar nodule indenting the optic chiasm. Features of cystic degeneration, calcification and hemorrhage were absent. After transsphenoidal surgery, MRI showed interval resolution of the previously noted pituitary nodule, with normal appearance of the pituitary gland, optic chiasm and pituitary stalk on (C) coronal and (D) sagittal views.
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case_images: Upon consult, cranial magnetic resonance imaging (MRI) showed an enhancing suprasellar mass measuring 1.3 cm x 1.3 cm x 1.4 cm indenting the optic chiasm, consistent with pituitary macroadenoma (Figures 1A and B). Post-operative cranial MRI showed interval resolution of the previously noted pituitary mass, with normal appearance of the pituitary gland including the optic chiasm and pituitary stalk (Figures 1C and 1D).
case_images: Photomicrograph showing granuloma formation characterized by central epithelioid, foamy macrophages and giant cells (H&E, 200x).
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case_images: The histologic features were consistent with chronic granulomatous inflammation with focal necrosis instead of a pituitary adenoma (Figure 2).
case_images: Cranial MRI upon recurrence of symptoms in (A) coronal and (B) sagittal views showing an enhancing left sellar nodule measuring 1.2 cm x 1.3 cm x 1.5 cm superiorly deviating the pituitary infundibulum to the right and abutting the optic chiasm.
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case_images: Cranial MRI showed a 1.2 cm x 1.3 cm x 1.5 cm enhancing left sellar nodule (Figure 3).
case_images: Cranial MRI in (A) coronal and (B) sagittal views after 3 months of steroid therapy showing complete resolution of the sellar nodule. A normal-sized pituitary gland, midline infundibulum and normal optic chiasm on both views (C and D) were seen approximately 6 months after treatment.
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case_images: After 3 months of steroid therapy, cranial MRI showed complete resolution of the sellar mass (Figures 4A and 4B). Upon reevaluation approximately 6 months post-treatment, cranial MRI showed no enhancing lesion in the pituitary gland (Figures 4C and 4D) and normal thyroid function (Table 2).