Pituitary Mimic: Sellar Meningioma in a Patient Undergoing Fertility Therapy

Sex hormones play a crucial role in the development and growth of meningioma. It was observed that meningiomas increase in size and become more symptomatic during pregnancy. Similarly, the use of hormonal therapy, including gonadotropin-releasing hormone (GnRH) agonist, can be associated with an increased risk for meningioma. We reported a 45-year-old woman with a past medical history of hypothyroidism and mild hyperprolactinemia who received hormonal therapy for infertility, including GnRH. She has experienced a persistent headache and left retro-orbital pain with eye movement. Her MRI brain scan revealed a soft tissue mass involving the sellar and left cavernous sinus with a slight impingement of the optic chiasm and left optic nerve, concerning for meningioma or pituitary adenoma. Further laboratory workup showed secondary adrenal insufficiency, which was treated with replacement glucocorticoid therapy. Following tumor resection and histological examination, the diagnosis of sellar meningioma was confirmed. This case report shows a rare association of fertility hormonal treatment with sellar meningioma and how it is challenging to distinguish meningioma from other sellar masses, such as pituitary adenoma, based on clinical presentation and imaging studies.