Behind the Sella: A Rare Case of Pituicytoma Mimicking a Pituitary Adenoma.
Katarzyna Wołos-Kłosowicz, Nina Suligowska-Wolszczuk, Michał Szklarz et al.
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Case in brief
A 48-year-old man presented with symptoms of hypogonadism, headaches, and visual field defects. Testing showed hypogonadotropic hypogonadism and hyperprolactinemia, while MRI revealed a sellar-suprasellar mass initially considered a prolactinoma. With no response to initial hormone replacement, the mass enlarged and visual impairment worsened, prompting resection through a right-temporal craniotomy. Histopathology and immunohistochemistry identified a CNS WHO grade 1 pituicytoma. Postoperatively, he had transient cognitive impairment and endocrine deficiencies requiring long-term hormone replacement.
What made this case unusual
The tumor clinically and radiologically resembled a prolactinoma, but tissue examination established pituicytoma; hyperprolactinemia was considered in the context of possible pituitary stalk compression.
Diagnostic / clinical pearl
A sellar-suprasellar mass with hyperprolactinemia is not necessarily a prolactinoma. When imaging is non-specific and the clinical course is discordant, histopathological confirmation may be essential to diagnosis.