Incidental White Matter Lesions and Pituitary Microadenoma in Postpartum Patient

Case at a Glance

A 38-year-old postpartum woman presents with concerns about white matter changes found incidentally during follow-up imaging for a known pituitary microadenoma, with associated behavioral and cognitive symptoms.

Patient's Story

This 38-year-old female, 6'3" tall, weighing 218 lbs, and 5 months postpartum with her third child, initially presented to the emergency department 8 years ago with suspected stroke symptoms that were ultimately diagnosed as a panic attack. During the workup, imaging revealed a 2mm pituitary growth. She was advised to follow up in 10 years. Following the birth of her third child, she returned for routine follow-up of the pituitary lesion. Recent imaging showed growth of the pituitary adenoma to 7mm. However, the patient became concerned when told about incidental white matter changes on her brain MRI. She reports a 4-year history of anger management issues, for which she has been attending anger management courses and therapy. She also notes memory problems, which she had attributed to 'baby brain' after having three children in 7 years.

Initial Assessment

Follow-up MRI with contrast was ordered to reassess the known pituitary adenoma. The patient appeared anxious about the findings, particularly the white matter changes. Physical examination was unremarkable. The patient expressed concern about potential correlation between her behavioral symptoms and imaging findings.

The Diagnostic Journey

MRI pituitary with and without contrast was performed using multiplanar, multisequence imaging with gadavist contrast. Dynamic contrast-enhanced imaging of the pituitary was included. The study was compared to previous imaging from 5 months prior.

Final Diagnosis

1. Stable pituitary microadenoma (6.8 x 5.6 x 4.9 mm) in the right adenohypophysis without suprasellar extension
2. Scattered foci of nonspecific white matter T2/FLAIR hyperintensities in bilateral cerebral hemispheres, stable from prior study
3. Incidental left maxillary sinus polyps

Treatment Plan

Conservative management with continued observation of the pituitary microadenoma. Patient education regarding the benign nature of incidental white matter lesions. Reassurance provided that these findings are common and typically not associated with neurological symptoms. Continued behavioral health support for anger management and postpartum adjustment.

Outcome and Follow-up

Patient was reassured by radiologist that the white matter lesions are among the most common incidental findings on MRI and are seen in many individuals without brain disease. The pituitary adenoma remains stable and poses no immediate danger. Patient scheduled for follow-up appointment with primary physician to discuss findings and address ongoing concerns. Continued therapy and anger management support recommended for behavioral symptoms.