An Unusual Cystic Sellar-Suprasellar Mass in a Young Female

Abstract

This is the magnetic resonance image (MRI) of the brain of a 23-year-old female with a 20-month history of headache, progressive blurring of vision, somnolence, constipation, cold intolerance and amenorrhea. Physical examination showed bitemporal hemianopsia and decreased muscle stretch reflexes for all extremities. She had normal serum sodium and urine specific gravity, modest elevation of prolactin level, low thyroxine level with inappropriately normal thyrotropin (secondary hypothyroidism), and markedly decreased 8 AM serum cortisol. The MRI of the head with gadolinium showed a moderate-sized peripherally enhancing sellar and suprasellar cystic mass measuring 3.3 x 3.6 x 4.0 centimeters which is partly hemorrhagic or containing proteinaceous material, that causes marked compression of the overlying optic apparatus. Imaging findings are most compatible with a craniopharyngioma. Figure 1. Sellar mass exhibiting pre-existing internal T1 hyperintensity and evidence of sedimentation leveling. Figure 2. The sellar mass is asymmetric towards the left, extending to the left cavernous sinus region. It causes mild to moderate expansion of the floor of the sella. This is the magnetic resonance image (MRI) of the brain of a 23-year-old female with a 20-month history of headache, progressive blurring of vision, somnolence, constipation, cold intolerance and amenorrhea. Physical examination showed bitemporal hemianopsia and decreased muscle stretch reflexes for all extremities. She had normal serum sodium and urine specific gravity, modest elevation of prolactin level, low thyroxine level with inappropriately normal thyrotropin (secondary hypothyroidism), and markedly decreased 8 AM serum cortisol. The MRI of the head with gadolinium showed a moderate-sized peripherally enhancing sellar and suprasellar cystic mass measuring 3.3 x 3.6 x 4.0 centimeters which is partly hemorrhagic or containing proteinaceous material, that causes marked compression of the overlying optic apparatus. Imaging findings are most compatible with a craniopharyngioma.