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Hamartomas of the tuber cinereum is a rare congenital mass lesion more frequently seen in boys, and is located between the mammillary bodies and pituitary stalk. Hamartoma is not a proper tumor but a congenital non-tumor heterotopia. On histology, a hamartoma consists of accumulations of small and large neurons, astrocytes and oligodendrocytes, which are in correct ratio with tuber cinereum tissue (Matsko and Korshunov 1998a, b). They do not invade the surrounding structures, but may progress slowly, sometimes reaching rather large sizes. The most frequent and early clinical manifestation occurs approximately at the age of 2 years: isosexual precocious puberty. Other signs such as epileptic seizures and behavioral changes occur later when a hamartoma acquires a diameter of about 10 mm (Mittal et al. 2013).

An empty sella refers to a condition in which an arachnoid diverticulum extends into the sella, often causing reshaping and flattening of the pituitary gland and stalk.

Excessive prolactin secretion is a not infrequent cause of anovulation and consequent infertility, often associated with amenorrhea or oligomenorrhea. Only hyperprolactinaemia causing ovulatory disturbance deserves treatment. Clinically, galactorrhea may be a sign of hyperprolactinaemia but galactorrhea may often occur without associated hyperprolactinaemia and vice-versa. Oligo/amenorrhea is a more important symptom which demands a serum prolactin estimation. Any disruption in the hypothalamic-pituitary pathway, (e.g. dopamine reducing medications, space occupying lesions) will raise prolactin concentrations and if these reach a certain level, ovulatory dysfunction will result. A further cause of hyperprolactinaemia is a prolactin-secreting tumour (prolactinoma) of the anterior pituitary which is autonomous in nature and may be a micro or a macroadenoma. Hypothyroidism is a further possible cause of hyperprolactinaemia as thyroid releasing hormone, secreted by the hypothalamus as a compensatory mechanism, has the property of prolactin release from the pituitary. The work-up following the finding of hyperprolactinaemia associated with oligo- or anovulation should include neuro-radiological visualization of the hypothalamic pituitary region by MRI or CT to look for a micro- or macroadenoma, empty sella syndrome or a para-sellar tumour. Serum TSH, FSH and LH should also be estimated. Visual disturbances associated with a visualized tumour should also prompt an examination of visual fields. A pituitary tumour impinging on the optic chiasma characteristically causes a bitemporal hemianopia. When hyperprolactinaemia and anovulatory infertility are associated with medication, the benefits and disadvantages of reducing dosage or withdrawing medication must be carefully weighed up. Hypothyroidism as a cause should be treated with the appropriate medication for correction of thyroid function rather than with specific prolactin-lowering agents. Many dopamine agonists are in use for the treatment of infertility associated with hyperprolactinaemia: bromocriptine carbergoline, quinagolide