Large Sellar and Suprasellar Mass (Pituitary Macroadenoma) With Left Third Nerve Palsy and Left Optic Tract Compression

A case of a large sellar and suprasellar pituitary macroadenoma with an associated left third nerve palsy and left optic tract compression. Images from an MRI of the brain with contrast illustrate the imaging characteristics and extent of the tumor. Figure 1 : Humphrey Visual Fields (24-2 SITA-Fast) showing a complete right homonymous hemianopia. Figure 2 : Sagittal T1 sequence showing an invasive mass (yellow arrows) involving the skull base that encases the internal carotid arteries (red arrow). Figure 3 : Sagittal T1 post-contrast image of an avidly-enhancing mass (arrows) involving the skull base with mass effect on the upper brainstem and midbrain. Figure 4 : Axial T1 sequence showing a large suprasellar mass with cystic components and fluid-density levels (yellow arrow). There is mass effect on the left cerebral peduncle (red arrow). Figure 5 : Axial T2 FLAIR sequence showing a large suprasellar mass with cystic components and fluid-density levels (yellow arrow). There is mass effect on the left cerebral peduncle (red arrow). Figure 6 : Extensive sellar and suprasellar mass (arrows) that extends into the bilateral cavernous sinuses, encases the internal carotid arteries, exerts mass effect on the cerebral peduncles, and infiltrates adjacent brain parenchyma.