Question

Case 2:

A 25-year-old woman has noted breast secretions for the past month. She is not breastfeeding and has never been pregnant. She has not menstruated for the past 5 months. Physical examination yields no abnormal findings. MRI of the brain shows a 0.7-cm mass within the sella turcica.

Q: What are your differential diagnoses? Why?

Answer 1

The sella turcica is depression present on the sphenoid bone where the pituitary gland is located. The sells turcica contains different tissues with varying morphology and cytology. Thus, a large number of diverging lesions can arise from the sellar region. The most common lesion found in sella turcica is a pituitary adenoma, (approx. 90 % of lesions), the other lesions contribute 10% of sellar lesions, includes craniopharyngioma, meningioma, and germ cell tumors. The craniopharyngioma is usually seen in children and older adults, and germ cell tumors are seen in younger adults below 20 years. But Meningioma is not usually seen in children.

Craniopharyngioma: It is a benign tumor of the pituitary gland embryonic cells

Meningioma: Tumor of the meninges, the covering layer of the brain

Germ cell tumors of the brain include germinomas and teratomas

From the above differential diagnosis of the sellar lesion, the most probable cause of the woman's condition is a pituitary adenoma. Prolactin-secreting pituitary adenomas may lead to hypogonadism in patients of both genders, infertility, and galactorrhea in women (the latter is very rare in men). Gonadotrophin secreting pituitary adenoma may cause oligomenorrhea or amenorrhea in women. Here in the question the 25-year-old woman experiencing galactorrhea and amenorrhea suggestive of prolactin-secreting pituitary adenoma.