Contribution of Magnetic Resonance Imaging in Non-Tumoral Hypopituitarism in Children

Abstract

Background: Magnetic resonance imaging (MRI) is of paramount importance for evaluating the hypothalamo-pituitary axis in children. Methods: We summarize the main points of the MRI technique, and describe the normal appearance of the hypothalamo-pituitary axis as a function of age and pubertal status. The most frequent causes of non-tumoral hypopituitarism include anterior pituitary deficiency (growth hormone deficiency may be isolated or associated with other anterior pituitary hormone deficiencies, with or without other malformations, and related to a known genetic abnormality in some cases), isolated hypogonadotropic hypogonadism and posterior pituitary deficiency with or without anterior pituitary hormone deficiency (central diabetes insipidus may be observed without tumor development). Results: We describe in detail the appearance of the adenohypophysis, the pituitary stalk and the neurohypophysis, correlations with hormone deficiencies, the abnormalities that may be associated and progression over time for each condition. Conclusion: An accurate description of hypothalamo-pituitary axis abnormalities is necessary for accurate diagnosis and prognosis evaluation, with certain features suggestive of particular diseases and some prognostic data correlated with phenotype.

Pituitary Stalk Dysgenesis-Induced Hypopituitarism in Adult Patients: Prevalence, Evolution of Hormone Dysfunction and Genetic Analysis

“…The results reported are from the most recent radiological study performed. The anterior pituitary gland was described as normal size (≥3 mm) or hypoplastic (<3 mm) using the maximum pituitary height (perpendicular measurement giving the greatest distance between the base and top of the gland) [28]. The maximum transverse diameter of the pituitary stalk was measured in coronal slices and was described as normal, thin (<2 mm) or absent [28].…”

“…The anterior pituitary gland was described as normal size (≥3 mm) or hypoplastic (<3 mm) using the maximum pituitary height (perpendicular measurement giving the greatest distance between the base and top of the gland) [28]. The maximum transverse diameter of the pituitary stalk was measured in coronal slices and was described as normal, thin (<2 mm) or absent [28]. The posterior pituitary bright spot was described as correctly or ectopically located at the pituitary stalk or median eminence [28].…”

Auxologic parameters and response to 2-year therapy with recombinant human growth hormone in growth hormone deficient children with an ectopic posterior pituitary

“…12-14 among auxiliary diagnostics methods, MRi has been gaining an apparent role as an indicator of hormonal deficiencies of the pituitary. 4,5,[15][16][17] according to the guidelines of several endocrine societies, GH stimulation tests are not necessary in the event of co-existence of clinical signs of GHD and structural anomalies of the hypothalamic-pituitary area in the MRi. 2 Pituitary stalk interruption syndrome with ectopia of the posterior pituitary (PSiS), characterized by the hyperintensive T1 signal, is one of the typical qualitative alternations in the MRi related to GHD.…”

“…2 Pituitary stalk interruption syndrome with ectopia of the posterior pituitary (PSiS), characterized by the hyperintensive T1 signal, is one of the typical qualitative alternations in the MRi related to GHD. 16,18 Based on the aforementioned reports, the aim of our study was to determine specifically whether patients diagnosed with GHD according to standardized biochemical criteria, varying in terms of the MRi of the hypothalamic-pituitary area, present different auxological characteristics before and during the substitution rhGH therapy. Patients and auxiliary examinations, including MRi, were assessed within one centre.…”

Neonatal Hypopituitarism: Diagnosis and Treatment Approaches

“…Brain and hypophysis imaging should be done in infants considered to have hypopituitarism, with the severity of the cases parallelling neuro-radiological abnormalities (18). Pituitary gland height, neurohypophysis brightness/ectopia, undescended posterior lobe, infundibulum morphology, absence of corpus callsum and septum pellucidum, optic nerve and chiasma, holoprosencephaly, schizencephaly, cerebellar hypoplasia, absence of fornix and Chiari malformation are noted with imaging (66). Lack of neurohypophysis brightness supports the diagnosis in central diabetes insipidus cases.…”