Rare Case of a Disappearing Pituitary Adenoma During the Coronavirus Disease 2019 (COVID-19) Pandemic

Abstract

We present a case of a 28-year-old woman with a history of severe headaches and pituitary insufficiency. She was found to have a large, enhancing, sellar mass consistent with a pituitary adenoma. The patient's surgical care was delayed due to the coronavirus disease 2019 (COVID-19) pandemic, and follow-up imaging revealed spontaneous involution of the sellar mass. Spontaneous involution of pituitary masses has been described but not often encountered in clinical practice. This case highlights that follow-up imaging is necessary when scheduling elective surgeries during the COVID-19 pandemic.

Keywords: COVID-19; Pituitary adenoma; Pituitary apoplexy.

Figure 1

(A and B) Sagittal and coronal plane reformats of magnetic resonance imaging (MRI) brain T1 sequence with gadolinium contrast revealing a large enhancing mass in the sella turcica with Knosp 3A cavernous sinus invasion bilaterally. The mass is avidly enhancing and abuts the optic chiasm. The imaging is most consistent with a pituitary adenoma. (C) Computed tomography of the head without contrast reveals hypodensity within an enlarged sella turcica. The previously noted pituitary mass is no longer observed. (D and E) Sagittal and coronal plane reformats of MRI brain T1 sequence with gadolinium contrast reveals resolution of the previously noted pituitary adenoma. There is a thin rim of enhancing tissue in the sella consistent with residual pituitary gland or scant tumor. (F) Coronal plane reformat of MRI brain T2 sequence without contrast without contrast.