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Ann Saudi MedAnn Saudi MedAnnals of Saudi Medicine0256-49470975-4466King Faisal Specialist Hospital and Research Centre 1792168010.5144/0256-4947.2007.381asm-5-381What's Your Diagnosis?A 37-year-old married woman with 3-month history of galactorrhoea and irregular menstrual cycle Das Chandan Jyoti *Debnath Jyotindu *Javan NG †Baruah Manash Pratim ‡
* Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
† Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
‡ Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, IndiaCorrespondence and reprint requests: Dr. Chandan Jyoti Das, All India Institute of Medical Sciences – Radiology, New Delhi 29, India New Delhi 110029, India, T: +91-11-2658500, F: +91-11-26588663Sep-Oct 2007 27 5 381 382 01 3 2007 Copyright © 2007, Annals of Saudi Medicine2007This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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A 37-year-old married woman presented to the gynecology outpatient department with 3 months history of galactorrhoea and irregular menstrual cycle. No history of visual problems could be elicited. After initial evaluation she was referred to the endocrinology department for further investigation of her hormonal status. The visual field examination revealed bitemporal hemianopsia on perimetry. Galactorrhoea was also observed. Her pertinent laboratory investigations included high serum calcium (14 mg/dL), high levels of serum prolactin (120 μg/L) and parathyroid hormone (110mEq/L).The thyroid stimulating hormone (TSH), cortisol, gonadotropins and serum calcitriol levels were normal. Two months later the patient presented with polyuria, polydipsia and bone pain. A high-resolution contrast-enhanced MRI (CEMRI) of the sella (Figure 1) and plain radiograph of the hands (Figure 2) was performed.

What are the abnormal findings on the MRI and the hand x-ray?

What additional studies are needed to make a diagnosis?

What is the likely diagnosis?

Answer on page: 388

Figure 1a T1W MRI sagittal section showing a sellar mass with hypointense center.

Figure 1b Peripheral rim enhancement is seen on post-gadolinium T1W sagittal image.

Figure 2 X-ray of the hands showing osteopenia and subperiosteal erosion in the phalanges (arrow).