Incidental Sellar Mass After An Accident

History of Present Illness

A 23 year old college student with no major medical history is brought to the emergency department (ED) by emergency medical services after a motor vehicle accident (MVA). She was a belted passenger in the front seat of a car when the car slid on ice at 40 miles per hour hitting the curb. There was no airbag deployment, but she hit her head against the window. The patient reports no loss of consciousness and was able to leave the car without assistance. A full trauma survey in the ED is negative for other injuries and cervical spine imaging is unremarkable. However, her head CT shows a sellar mass. The patient has headaches and mild nausea but denies any vision loss, tingling, numbness or weakness. Despite receiving analgesic medication, she continues to have persistent headaches, thus the ED team obtained a brain MRI which shows a 2 by 2 cm contrast-enhancing sellar mass.

On further questioning, the patient reports a history of amenorrhea for 6 months and weekly headaches for the past 10 years. Her headaches are frontal and usually worsen with bright lights. These are accompanied with nausea and resolve with acetaminophen. She has a history of acne and was placed on spironolactone 6 months ago. After the spironolactone was started, her periods disappeared. The medication was stopped after 2 months, but her periods did not return until 2 weeks ago. She attributed it to the drug and has not had any further work-up. The patient denies any vision changes, fatigue, cold or heat intolerance, weight change, polyuria, polydipsia, galactorrhea, or change in size of hands and feet. She is not on anticoagulant or antiplatelet medications.