Pituitary microadenoma (prolactinoma, treated)


Image 1

Clinical History: 
A 31 year-old woman with long-standing infertility, who prior to treatment presented with galactorrhea, now on cabergoline.

Pituitary microadenoma (prolactinoma, treated)

MR Technique:
3 mm coronal FSE (15 echoes) T2- and SE immediate post-contrast T1-weighted images are presented, acquired at 1.5 T on a Siemens Espree MR system. Sequence parameters were TR/ TE = 4000/95 and 414/17, respectively. Scan times were 2:20 and 4:28 min:sec.

Imaging Findings:
A small lesion is seen within the left aspect of the sella (with very high signal intensity on T2-, and low signal intensity on post-contrast T1-weighted images), measuring 5 mm in transverse dimension, which was not significantly changed from prior study (images not shown). This lesion appears predominantly cystic on the current study, due to the very high signal intensity on the T2-weighted image. There was evidence of a small amount of intratumoral hemorrhage (methemoglobin) with high signal intensity on the pre-contrast T1-weighted images, consistent with a treated pituitary microadenoma (image not shown). A small portion of the lesion demonstrated enhancement (image not shown). No extension into the suprasellar cistern is present.
Relative to medical treatment of pituitary prolactinomas, cabergoline, a dopamine D2 receptor agonist, is prescribed as first-line therapy. It has a direct inhibitory effect on prolactin cells within the pituitary. It has largely replaced bromocriptine for management of prolactinomas due to higher receptor affinity and less severe side effects.