PMC7784170_01
(A) Coronal post contrast T1-weighted image showing pituitary enlargement with dome-shaped convexity. (B) Coronal post contrast T1-weighted image showing lesion disappearing 6 months after levothyroxine supplementation.
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The cranial Magnetic Resonance Imaging (MRI) showed pituitary space occupying lesion (SOL) with a size of 15x10x22 mm abutting the optic chiasma with minimal para-sellar extension into the cavernous sinus inferiorly (Figure 1A). Follow-up MRI after 6 months revealed complete resolution of the hyperplastic pituitary (Figure 1B).
PMC7784170_02
(A) Coronal post contrast T1-weighted image showing dome-shaped superior convexity of the pituitary prior to starting levothyroxine therapy. (B) Post coronal T1-weighted image showing post-levothyroxine therapy depicting total resolution of the thyrotroph hyperplasia and obliteration of the "dome."
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TSH >100 microIU/mL, free T4 5.8 pmol/L, prolactin 57.78 microg/L. The MRI (Figure 2) was similar to patient 1 with a domeshaped superior protrusion of the pituitary gland almost abutting the optic chiasma.
PMC7784170_03
Preoperative coronal T1-weighted image depicting similar pituitary enlargement as in Figures 1 and 2.
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She was referred in the post-operative period for diabetes insipidus; however, initially sent to the neurosurgical team for a pituitary macroadenoma (Figure 3).