Clinical features of patients with pituitary stalk thickening: a review of 159 cases from one medical center

Cai, Yanjiao; Shou, Xuefei; Zhang, Zhaoyun; Ye, Hongying; Zhao, Yao; Wang, Yongfei; Xie, Rong; Li, Shiqi; Li, Yiming

doi:10.1186/s41016-016-0070-3

Cited by 5 publications

(4 citation statements)

References 14 publications

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“…Numerous studies confirmed that CDI was the most common initial symptom of PST ( 2 , 4 , 9 ). Every pediatric patient with CDI should undergo MRI imaging of the pituitary hypothalamic axis to confirm the diagnosis and perhaps determine the etiology ( 10 ).…”

Section: Discussionmentioning

confidence: 95%

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Pituitary Stalk Thickening: Causes and Consequences. The Children’s Memorial Health Institute Experience and Literature Review

et al. 2022

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BackgroundPituitary stalk thickening (PST) is a rare abnormality in the pediatric population. Its etiology is heterogeneous. The aim of the study was to identify important clinical, radiological and endocrinological manifestations of patients with PST and follow the course of the disease.Materials and MethodsIt is a study conducted in 23 patients (13 boys) with PST with/without central diabetes insipidus (CDI) diagnosed between 1990 and 2020 at Children’s Memorial Health Institute (CMHI) in Warsaw, Poland. We analyzed demographic data, clinical signs and symptoms, radiological findings, tumor markers, hormonal results, treatment protocols and outcomes.ResultsThe median age at the diagnosis of PST was 9.68 years (IQR: 7.21-12.33). The median time from the onset of the symptoms to the diagnosis was 2.17 years (IQR: 1.12-3.54). The most common initially reported manifestations were polydipsia, polyuria and nocturia (82.6%); most of the patients (56.5%) also presented decreased growth velocity. Hormonal evaluation at the onset of PST revealed: CDI (91.3%), growth hormone deficiency (GHD) (56.5%), hyperprolactinemia (39%), central hypothyroidism (34.8%), adrenal insufficiency (9%), precocious puberty (8.7%). The majority of the patients were diagnosed with germinoma (seventeen patients – 73.9%, one of them with teratoma and germinoma). Langerhans cell histiocytosis (LCH) was identified in three patients (multisystem LCH in two patients, and unifocal LCH in one patient). A single case of atypical teratoid rhabdoid tumor, suspected low-grade glioma (LGG) and lymphocytic infundibuloneurohypophysitis (LINH). The overall survival rate during the observational period was 87.0%.ConclusionsThe pituitary infundibulum presents a diagnostic imaging challenge because of its small size and protean spectrum of disease processes. Germinoma should be suspected in all children with PST, especially with CDI, even when neurological and ophthalmological symptoms are absent.

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Section: Discussionmentioning

confidence: 95%

“…There are various reasons for PST, such as neoplastic, inflammatory or infectious diseases ( 1 ). PST mainly affects teenagers and is often detected with magnetic resonance imaging (MRI) in patients with central diabetes insipidus (CDI) ( 2 ). Pituitary stalk lesions are sometimes accidentally detected during brain MRI.…”

Section: Introductionmentioning

confidence: 99%

Pituitary Stalk Thickening: Causes and Consequences. The Children’s Memorial Health Institute Experience and Literature Review

et al. 2022

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“…In the Mayo Clinic study, 43 out of 152 enrolled patients presented with DI, with at least 1 of the anterior pituitary axes being insufficient in 49 cases (32%), and with hypogonadotropic hypogonadism as the most common deficit [ 13 ]. Cai et al confirmed anterior pituitary lobe dysfunction in almost half of the patients [ 15 ]. Furthermore, a high percentage of GHD (84.9%) and central hypogonadism (64.1%), followed by secondary hypothyroidism and hypocorticism (both at 45.2%) were described by Doknic et al [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Diversity of Pathological Conditions Affecting Pituitary Stalk

Kluczyński

Godlewska

Wójcik

et al. 2021

JCM

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Pituitary stalk lesions (PSL) are a very rare pathology. The majority of conditions affecting the infundibulum do not present with clinically apparent symptoms, what makes the diagnosis difficult. The recognition might be also complicated by the non-specific and transient characteristics of hormonal insufficiencies. In our study, we retrospectively analysed demographic, biochemical, and clinical long-term data of 60 consecutive, unselected adult patients (34 women and 26 men) with PSL diagnosed in the Department of Endocrinology, Jagiellonian University in Krakow. The diagnosis of PSL were categorized as confirmed, probable, or undetermined in 26, 26 and 8 patients, accordingly. Given the possible aetiology congenital, inflammatory, and neoplastic stalk lesions were diagnosed in 17, 15 and 20 patients, accordingly. In eight cases the underlying pathology remained undetermined. The most common pituitary abnormality was gonadal insufficiency diagnosed in 50.8% of cases. Diabetes insipidus was detected in 23.3% of cases. In 5% of patients the pituitary function recovered partially over time. Stalk lesions were extensively discussed in the context of the current literature. Based on the published data and our own experience a diagnostic algorithm has been proposed to help physicians with the management of patients with this challenging condition.

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“…1, 2 ). PST mainly affects teenagers and is often detected with magnetic resonance imaging (MRI) in patients with central diabetes insipidus (CDI) [ 1 ]. Sometimes, pituitary stalk lesions are accidentally detected during brain MRI.…”

Section: Introductionmentioning

confidence: 99%

Pituitary stalk thickening in patients under 18 years of age – the most common causes and diagnostic procedures

Moszczyńska¹,

Baszyńska-Wilk²,

Zasada³

et al. 2022

pedm

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Introduction Pituitary stalk thickening (PST) is a rare abnormality in children, and it may be challenging due to its diverse clinical picture. The aim of the study is to summarize the data on the causes and diagnostic procedures of PST. Material and methods Papers were searched in the PubMed database identifying published randomized clinical trials, reviews, systematic reviews, meta-analyses, and case reports. Results The most common causes of a thickened pituitary stalk in children are germ cell tumours (GCTs), Langerhans cell histiocytosis (LCH), and lymphocytic infundibulo-neurohypophysitis (LINH). Neurosarcoidosis, pituitary tuberculosis, granulomatosis, or specific inflammations were only reported in the paediatric population as case studies. PST mainly affects teenagers and is often detected with brain magnetic resonance imaging (MRI) in patients with central diabetes insipidus (CDI). It is not possible to differentiate the causes of PST with the use of the MRI image alone. Although various biochemical and oncological markers and other imaging tests are used, the diagnosis of PST remains a significant diagnostic challenge for clinicians. The final diagnosis is made based on histopathological examination. The indications for a biopsy are not uniform. Most experts, including the authors of the 2021 British consensus, recommend biopsy in the case of PST with a stalk lesion diameter ≥ 6.5–7 mm. Conclusions The differential diagnosis of PST is a challenge. The diagnostic and treatment strategy should be individually adapted. Patients should be diagnosed in large clinical centres with experience in this field.

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Clinical features of patients with pituitary stalk thickening: a review of 159 cases from one medical center

Cited by 5 publications

References 14 publications

Pituitary Stalk Thickening: Causes and Consequences. The Children’s Memorial Health Institute Experience and Literature Review

Pituitary Stalk Thickening: Causes and Consequences. The Children’s Memorial Health Institute Experience and Literature Review

Diversity of Pathological Conditions Affecting Pituitary Stalk

Pituitary stalk thickening in patients under 18 years of age – the most common causes and diagnostic procedures

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