Pituitary macroadenoma: T1W sagittal (A) and coronal (B) and T1W gadolinium-enhanced coronal (C) images of the pituitary fossa show expansion of the sella.

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Pituitary macroadenoma: T1W sagittal (A) and coronal (B) and T1W gadolinium-enhanced coronal (C) images of the pituitary fossa show expansion of the sella by a cystic pituitary mass. Pituitary macroadenoma: T1W sagittal (A) and coronal (B) and T1W gadolinium-enhanced coronal (C) images of the pituitary fossa show expansion of the sella by a cystic pituitary mass. The pituitary macroadenoma extends upwards through the diaphragma, forming a waist, and distorts the optic chiasm in the suprasellar cistern. The infundibulum is distorted and the axoplasmic flow of pituitary hormones interrupted—note the posterior pituitary displacement into the suprasellar cistern (arrow, B). There is likely to be cavernous sinus invasion because one-third of cavernous internal carotid arteries will abut the tumour mass. Shelley Renowden Pract Neurol 2015;15:26-41 ©2015 by BMJ Publishing Group Ltd