The MR scans demonstrated a large pituitary tumour with cystic and solid components. The patient underwent a subfrontal craniotomy to debulk the tumour. Because of invasion of the sphenoid sinus and left cavernous sinus, it was not possible to remove the tumour completely. The patient is now undergoing radiotherapy to the residual tumour. Macroadenomas are usually slow-growing and clinically silent until they present with pressure symptoms.
Suprasellar extension is most common, followed by lateral extension into the cavernous sinus.
Tumour necrosis, haemorrhage and cyst formation are all common complications in larger tumours, presumably due to the tumour outgrowing the blood supply. The presence of calcification should suggest an alternative diagnosis such as craniopharyngioma. Necrosis and tumour haemorrhage are not uncommon, even in asymptomatic patients. It is particularly important to exclude the possibility of a giant carotid aneurysm. Aneurysms have a laminated intramural thrombus, as well as areas of signal void on MR imaging but can be confused with macroadenomas, which may also have intratumoural haemorrhage.