Recurrent non-functioning pituitary adenoma

Case contribution: Dr Radhiana Hassan


  • A 29 years old Malay lady, no known medical illness
  • Presented with progressive blurred vision associated with headache, retro orbital pain and vomiting
  • Clinical examination shows bitemporal inferior quadrantopia
  • Patient also has hypothyroidism and hypocortisolism
  • Proceed with endoscopic transphenoidal hypophysectomy.
  • However, unable to fully excise tumor in view of close proximity to ICA.
  • Post operatively visual field improving. Previous bitemporal hemianopia resolved.
  • Patient was discharged well with hormonal replacement therapy (hypocortisolism, hypogonadotrophic hypogonadism, hypothyroidism).
  • Patient presented with headache and blurred vision after 3 months post operation.
MRI pituitary in axial planes
MRI in sagittal and coronal planes

MRI findings:

  • A large sellar mass extending to suprasellar region
  • It is isointense on T1WI, hypointense on T2WI and shows homogenous enhancement post contrast
  • Invasion to cavernous sinus with encasement of both ICAs
  • Both ICAs are patent
Serial MRI after the operation shows residual tumour and recurrence with compression effect to the optic chiasm (red arrow). The initial central tumour (blue arrow) has been removed.

Diagnosis: Residual and recurrent non-functioning pituitary adenoma (HPE-proven)


  • Non-functioning pituitary adenoma (NFPA) is the most frequent type of pituitary tumour
  • It often presents as a macroadenoma larger than 10mm
  • It can cause symptoms related to mass effect i.e compression of the optic apparatus causing bitemporal hemianopia.
  • Patients can have hypopituitarism secondary to compression of the normal pituitary gland.
  • Transphenoidal surgery is the treatment of choice.
  • Recurrence of NFPA occurs between 1-5 years after surgery and decreases after 10 years.
  • Suprasellar extension is commonest, followed by cavernous sinus and infrasellar in
  • Residual or recurrent tumour can be treated with radiotherapy, stereotactic radiosurgery or repeat surgery.
Author: radhianahassan