Spontaneous Resolution of Pituitary Cystic Lesion
The patient is a 67-year-old lady who presented in 2012 due to hemifacial spasm
involving the right lower eyelid, for which she subsequently underwent magnetic
resonance imaging for assessment of her right facial nerve anatomy.
A 1 cm pituitary mass was found incidentally present centrally and slightly on left
side of midline, having slightly high T1 signal without contrast
enhancement and no optic chiasm compression Vision was normal.
The lesion was thought to be cystic with either haemorrhagic or mucinous contents,
with possibilities of a cPA and unusual RCC.
Further testing revealed a low serum cortisol that responded appropriately to
a short synacthen test by rising to 718 nmol/L at one hour.
Follow-up scans performed in 2013 and 2014 showed no change.
Subsequent MRI in 2015 and 2016 showed progressive reduction in size
of the lesion with persistent slightly high T1 signal without obvious contrast enhancement.
Further follow-up scan in 2017 showed further significant reduction
in size of the lesion, now seen as a tiny eccentric nodule with high
T1 signal on superior aspect of left side of pituitary gland.
The overall size of pituitary gland appears quite small in Figure
3, with appearance of “empty sella” and prominent cerebrospinal
fluid space superiorly.
In retrospect, the “normal” pituitary tissue in Figures 1 and 2 is also quite less,
suggesting that it has been a pre-existing finding and appears more obvious in
due to shrinkage of the cyst.
Neuro Open J. 2020; 7(1): 1-4. doi: 10.17140/NOJ-7-133
