Correct! The arrow is pointing to an area of high signal on this sagittal pre-contrast T1-weighted MRI scan. That white area lies within a mass that appears to arise within the sella turcica. No separate pituitary gland is visible, so likely the mass is the pituitary gland itself—a pituitary adenoma. Bright signal on pre-contrast T1 MRI can be caused by fat, protein, some forms of calcium, melanin, slowly-flowing intravascular blood, and methemoglobin from fresh extravascular blood. In this case, it is extravascular blood within the pituitary gland, a phenomenon called “pituitary apoplexy.” Do not confuse this phenomenon with the pituitary infarction that occurs after pregnancy (Sheehan syndrome). Pituitary apoplexy is bleeding without infarction. The bleeding may expand the gland to cause pressure on the diaphragma sellae (headache), on the optic chiasm (bitemporal hemianopia), or on the cavernous sinus (ophthalmoplegia). Transsphenoidal surgery is usually performed promptly, often with excellent restoration of vision and normal ocular alignment.

Incorrect

Incorrect