Macroadenoma hipofisario. Y cual Juan M 22 septiembre, Es muy importante que te atiendas por que el tumor puede estar presionando el quisma optico y puedes perder la vista. Susana 8 marzo, Hola!!! Soy psicologa.

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Imaging differential diagnosis Clinical presentation Patients typically present with symptoms of local mass effect on adjacent structures especially optic chiasm. Some may present hormonal imbalance, with symptoms of hypopituitarism from compression or secretion.

Hormonal imbalance due to overproduction tends to present earlier and tumors are thus usually small at presentation. This mode of presentation is discussed in the article on pituitary microadenomas. Rarely pituitary apoplexy may present acutely and often catastrophically.

The rest is divided between pre and postfixed chiasms. A macroadenoma growing superiorly out of the pituitary fossa or for that matter other pituitary region masses will contact, elevate and compress the central part of the chiasm in most individuals.

This central part carries fibers from the nasal retina, and thus results in the classical bitemporal hemianopia Patients typically complain of bumping into things or having car accidents, but as the macular fibers are often spared, they may not be aware of actual visual deficits. In cases of prefixed or postfixed chiasms, or when the macroadenoma grows asymmetrically, then the optic nerves or optic tracts can be compressed, resulting in a variety of visual deficits.

Cavernous sinus invasion Some macroadenomas demonstrate invasive growth, and extension into the cavernous sinuses is characteristic. Prolactin-secreting tumors are most frequently responsible for cavernous sinus extension, and typically prolactin levels increase significantly when the tumor gains access to the sinus Once in the sinus, these tumors are difficult to resect completely.

Pathology Most macroadenomas are non-secretory endocrinologically inactive. Because these tumors are typically slow-growing, the pituitary fossa is almost invariably enlarged with thinned remodeled bone.

CT Non-contrast attenuation can vary depending on hemorrhagic, cystic and necrotic components. Adenomas which are solid, without hemorrhage, typically have attenuation similar to the brain HU and demonstrates moderate contrast enhancement; less marked than one typically sees in meningiomas.

Calcification is rare. MRI MRI is the preferred imaging modality, not only able to delineate the mass exquisitely but also clearly visualize the optic chiasm, anterior cerebral vessels, and cavernous sinuses. Generally, the more laterally a tumor extends into the cavernous sinus, and the more it encircles the internal carotid artery, the greater the likelihood of invasion.

The most convenient method is to assess the degree of encasement of the cavernous portion of the internal carotid artery. Less than 90 degrees makes involvement of the sinus very unlikely, whereas greater than degrees makes involvement almost certain Pituitary macroadenomas are highly hypermetabolic both with FDG and choline tracers. Differential diagnosis The differential of a pituitary macroadenoma is essentially the list of conditions leading to a pituitary region mass.

The most common considerations include: often in the setting of known disseminated malignancy often less well defined.


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