The Incidence of Calcified Pituitary Macroadenomas: Challenging the Craniopharyngioma Assumption

Large sellar/suprasellar masses containing calcifications are classically associated with craniopharyngiomas. In our practice, however, we have noticed that some giant pituitary macroadenomas have calcifications. The purpose of our study was to evaluate the incidence and characteristics of calcifications in pituitary macroadenomas.

We reviewed an internal database for pathology-proven giant macroadenomas (≥4 cm). Basic patient demographics were collected, including age and sex. Adenoma subtype and maximum adenoma dimension were recorded. Preoperative CT images were reviewed for capsular (none, thin, coarse, or mixed) and internal calcifications (none, thin, coarse, or mixed). Preoperative MR images were also reviewed to further characterize the adenoma (solid, cystic, and mixed; T1 signal).

Forty-five macroadenomas were included. The mean size was 47.4 mm (SD, 6.2 mm; range, 40-70 mm); 44.4% (95% CI, 30.9%-58.8%) of macroadenomas (20/45) had surrounding calcification. Ten (22%; 95% CI, 12.5%-36.3%) were from the expanded or destroyed dorsum sella, not the adenoma. Ten (22%; 95% CI, 12.5%-36.3%) cases had calcification directly from the adenoma. No cases had internal calcification. All were thin capsular calcification: 6 were thin, 3 were coarse, and 1 was mixed.

Large sellar/suprasellar masses that contain calcification are classically associated with craniopharyngiomas. We evaluated pathology-confirmed giant adenomas and found that 22% demonstrated the presence of calcifications on CT.