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the most common cause of sellar calcification is craniopharyngioma but it can be seen very rarely in pituitary adenomas and rathke 's cleft cysts .
incidence of calcification in pituitary adenoma on imaging varies from 0.8 to 8.0% , but usually it is < 2% .
pituitary calcification has been reported most commonly in prolactinoma , somatotroph adenoma , thyrotroph adenoma and rarely in gonadotroph and corticotroph adenoma . here
we report a case of pituitary calcification , which was earlier thought to have pituitary apoplexy because of findings on imaging .
however , on follow up he had normal pituitary functions and findings on imaging remain unchanged and were suggestive of pituitary calcification .
a 32-year - old male reported for review after three years of an episode of headache , vomiting , and confusional state when he was posted to high altitude area , when his computerized tomography ( ct ) scan of the sella showed a mildly enlarged sella with hyperdensity within the adenohypophysis [ figure 1a ] and magnetic resonance imaging ( mri ) revealed focal hyperintensity within the pituitary on t1 weighted imaging [ figure 1b ] which appeared hypointense on t2 weighted scans [ figure 1c ] .
his hormonal evaluation showed normal thyroid ( ft4 - 1.5 ng / dl , tsh - 1.72 miu / l ) , adrenal ( basal cortisol - 10.6 g / dl , stimulated cortisol-29.12 g / dl ) , gonadal ( lh - 6.78 iu / l , fsh - 7.97 iu / l , testosterone - 4.08 ng / ml ) and prolactin levels ( 9.97 ng / ml ) . mri and ct done for the sella revealed unchanged findings compared to the previous imaging done in 2009 [ figure 2a - c ] .
he was diagnosed as a case of non - functioning pituitary adenoma with pituitary calcification . in view of normal visual perimetry and pituitary function with no progression of lesion for three years
( a ) ct scan showing hyperdense lesion in sella ; ( b ) t1 weighted hyperintensity and ( c ) t2 weighted hypointensity in the sellar region in mri in 2009 ( a ) ct scan showing hyperdense lesion in sella ; ( b ) t1 weighted hyperintensity and ( c ) t2 weighted hypointensity in the sellar region in mri in 2012
surprisingly most of reports of pituitary calcifications are from japan and few from other countries in asia including india .
though calcifications in pituitary adenomas are rare on imaging , a higher incidence of microscopically proven calcified adenomas has been recently reported .
ncct and mri pituitary showed hyper - dense lesion and t1 weighted focal hyper - intensity within the pituitary respectively , suggestive of hemorrhage .
hormonal evaluation revealed evidence of secondary adrenal insufficiency , hence was diagnosed as a case of pituitary apoplexy .
horiuchi et al . , reported a case of male prolactinoma with pituitary calcification who also had features of hypopituitarism .
, to explain pituitary stone in a case of acromegaly . in present case , sella is enlarged ; hence there is high probability of pituitary adenoma which is hormonally inactive .
however , normal pituitary function makes pituitary apoplexy in the past unlikely but possibility can not be rules out .
he had normal libido and had a child about 6-year old , which also indicate unlikelihood of long standing prolactinoma or hypopituitarism in the past .
t1 weighted hyperintensity of the sellar region at mri is a common finding due to vasopressin storage in the posteriorly located neurohypophysis .
it is also seen normally in newborns and pregnant or lactating women due to hyperactive hormone secretion in the anteriorpituitary .
pathologically , t1 weighted hyperintensity can be caused by blood as in hemorrhagic pituitary adenoma , pituitary apoplexy or by the presence of a high concentration of protein in rathke 's cleft cyst , craniopharyngioma , or mucocele , by presence of fat in lipoma , dermoid cyst , and lipomatous meningioma , and due to calcificationas in craniopharyngioma , and sometimes due to presence of paramagnetic substance like manganese or melanin . in our case presence of calcification on
firstly , calcifications in the intratumoral hematoma ; secondly , calcifications in the degenerative adenoma tissue ; and finally , scattered psammoma bodies between the adenoma cells .
other types of calcification were thought to be the result from degenerative or hemorrhagic change of the adenoma . in our case surgical intervention
was deferred in view of asymptomatic , non - progressive nature of lesion , hence histopathology of the lesion is not available .
pituitary calcification occurs commonly in lactotroph or somatotroph adenoma but rare in chomophobe or gonadotroph adenoma . on imaging 
 , it can mimic hemorrhage , hence may masquerade pituitary apoplexy if patient present with neurological manifestations . 
 we present a case of pituitary calcification which mimicked pituitary apoplexy .