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Imaging of pediatric pituitary endocrinopathies.

Chaudhary V, Bano S - Indian J Endocrinol Metab (2012)

Bottom Line: Neuroimaging can be normal or disclose abnormalities related to pituitary-hypothalamic axis like (i) congenital and developmental malformations; (ii) tumors; (iii) cystic lesions; and (iv) infectious and inflammatory conditions.Classical midline anomalies like septo-optic dysplasias or corpus callosum agenesis are commonly associated with pituitary endocrinopathies and also need careful evaluation.In this radiological review, we will discuss neuroendocrine disorders related to hypothalamic pituitary-axis.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis, Employees' State Insurance Corporation (ESIC) Model Hospital, Gurgaon, Haryana, India.

ABSTRACT
Accurate investigation of the hypothalamic-pituitary area is required in pediatric patients for diagnosis of endocrine-related disorders. These disorders include hypopituitarism, growth failure, diencephalic syndrome, delayed puberty, precocious puberty, diabetes insipidus, syndrome of inappropriate antidiuretic hormone (SIADH) secretion, and hyperpituitarism. Magnetic resonance imaging (MRI) is the modality of choice to visualize hypothalamic-pituitary axis and associated endocrinopathies. Neuroimaging can be normal or disclose abnormalities related to pituitary-hypothalamic axis like (i) congenital and developmental malformations; (ii) tumors; (iii) cystic lesions; and (iv) infectious and inflammatory conditions. Classical midline anomalies like septo-optic dysplasias or corpus callosum agenesis are commonly associated with pituitary endocrinopathies and also need careful evaluation. In this radiological review, we will discuss neuroendocrine disorders related to hypothalamic pituitary-axis.

No MeSH data available.


Related in: MedlinePlus

Pituitary microadenoma: Coronal FLAIR (fluid attenuated inversion recovery) (a) and routine T1-weighted postcontrast (b) images of brain show a small nodular lesion (thin white arrow) involving right side of the pituitary gland producing mild bulge of superior margin of the gland and leftward deviation of pituitary stalk (thick white arrow). The lesion appears isointense to the gland on FLAIR image and shows enhancement pattern almost identical to the normal pituitary gland. High resolution dynamic contrast enhanced T1-weighted coronal image (c) of brain of another patient (at 60 seconds) shows a small nonenhancing (dark) microadenoma (thin black arrow) lateralized to the right side of the pituitary gland. Note that the lesion is more conspicuous on dynamic contrast scan as compared with routine contrast scan (seen in Figure 5b). The normal pituitary gland shows marked homogenous enhancement and there is no deviation of pituitary stalk (thin white arrow) in this case. [Reproduced with permission from Indian Journal of Endocrinology and Metabolism]
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Figure 5: Pituitary microadenoma: Coronal FLAIR (fluid attenuated inversion recovery) (a) and routine T1-weighted postcontrast (b) images of brain show a small nodular lesion (thin white arrow) involving right side of the pituitary gland producing mild bulge of superior margin of the gland and leftward deviation of pituitary stalk (thick white arrow). The lesion appears isointense to the gland on FLAIR image and shows enhancement pattern almost identical to the normal pituitary gland. High resolution dynamic contrast enhanced T1-weighted coronal image (c) of brain of another patient (at 60 seconds) shows a small nonenhancing (dark) microadenoma (thin black arrow) lateralized to the right side of the pituitary gland. Note that the lesion is more conspicuous on dynamic contrast scan as compared with routine contrast scan (seen in Figure 5b). The normal pituitary gland shows marked homogenous enhancement and there is no deviation of pituitary stalk (thin white arrow) in this case. [Reproduced with permission from Indian Journal of Endocrinology and Metabolism]

Mentions: ACTH releasing adenomas or childhood corticotropinomas associated with Cushing's disease, although rare in familial setting, are common in the context of multiple endocrine neoplasia type 1 (MEN 1).[32] Corticotroph adenomas are significantly smaller (usually 3 mm or less) than other types of pituitary tumors. Pituitary microadenomas (< 1 cm size) are identified as an area of low signal on T1-weighted sequences than the normal pituitary gland. Dynamic scanning with gadolinium [Figure 5] improves the sensitivity of pituitary microadenomas, particularly when conventional MR imaging is negative. The microadenomas appear less vascular (hypointense) on initial arterial phase of contrast enhancement but then equilibrate to show similar vascularity to normal gland in next few minutes.[33] Remodeling of floor of sella, stalk deviation away from the adenoma or upward convexity of the gland are useful features to identify the presence of microadenoma. Occasionally, patients with Cushing's syndrome may require petrosal venous sampling for localization of the source of ACTH secretion, particularly when MRI has been equivocal or negative.[34] The most characteristic clinical presentation of Cushing's disease is significant weight gain and severe failure to gain height. Other common symptoms include headache, hypertension, glucose intolerance, delayed puberty, amenorrhea, virilization and hirsutism.[35]


Imaging of pediatric pituitary endocrinopathies.

Chaudhary V, Bano S - Indian J Endocrinol Metab (2012)

Pituitary microadenoma: Coronal FLAIR (fluid attenuated inversion recovery) (a) and routine T1-weighted postcontrast (b) images of brain show a small nodular lesion (thin white arrow) involving right side of the pituitary gland producing mild bulge of superior margin of the gland and leftward deviation of pituitary stalk (thick white arrow). The lesion appears isointense to the gland on FLAIR image and shows enhancement pattern almost identical to the normal pituitary gland. High resolution dynamic contrast enhanced T1-weighted coronal image (c) of brain of another patient (at 60 seconds) shows a small nonenhancing (dark) microadenoma (thin black arrow) lateralized to the right side of the pituitary gland. Note that the lesion is more conspicuous on dynamic contrast scan as compared with routine contrast scan (seen in Figure 5b). The normal pituitary gland shows marked homogenous enhancement and there is no deviation of pituitary stalk (thin white arrow) in this case. [Reproduced with permission from Indian Journal of Endocrinology and Metabolism]
© Copyright Policy - open-access
Related In: Results  -  Collection

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Figure 5: Pituitary microadenoma: Coronal FLAIR (fluid attenuated inversion recovery) (a) and routine T1-weighted postcontrast (b) images of brain show a small nodular lesion (thin white arrow) involving right side of the pituitary gland producing mild bulge of superior margin of the gland and leftward deviation of pituitary stalk (thick white arrow). The lesion appears isointense to the gland on FLAIR image and shows enhancement pattern almost identical to the normal pituitary gland. High resolution dynamic contrast enhanced T1-weighted coronal image (c) of brain of another patient (at 60 seconds) shows a small nonenhancing (dark) microadenoma (thin black arrow) lateralized to the right side of the pituitary gland. Note that the lesion is more conspicuous on dynamic contrast scan as compared with routine contrast scan (seen in Figure 5b). The normal pituitary gland shows marked homogenous enhancement and there is no deviation of pituitary stalk (thin white arrow) in this case. [Reproduced with permission from Indian Journal of Endocrinology and Metabolism]
Mentions: ACTH releasing adenomas or childhood corticotropinomas associated with Cushing's disease, although rare in familial setting, are common in the context of multiple endocrine neoplasia type 1 (MEN 1).[32] Corticotroph adenomas are significantly smaller (usually 3 mm or less) than other types of pituitary tumors. Pituitary microadenomas (< 1 cm size) are identified as an area of low signal on T1-weighted sequences than the normal pituitary gland. Dynamic scanning with gadolinium [Figure 5] improves the sensitivity of pituitary microadenomas, particularly when conventional MR imaging is negative. The microadenomas appear less vascular (hypointense) on initial arterial phase of contrast enhancement but then equilibrate to show similar vascularity to normal gland in next few minutes.[33] Remodeling of floor of sella, stalk deviation away from the adenoma or upward convexity of the gland are useful features to identify the presence of microadenoma. Occasionally, patients with Cushing's syndrome may require petrosal venous sampling for localization of the source of ACTH secretion, particularly when MRI has been equivocal or negative.[34] The most characteristic clinical presentation of Cushing's disease is significant weight gain and severe failure to gain height. Other common symptoms include headache, hypertension, glucose intolerance, delayed puberty, amenorrhea, virilization and hirsutism.[35]

Bottom Line: Neuroimaging can be normal or disclose abnormalities related to pituitary-hypothalamic axis like (i) congenital and developmental malformations; (ii) tumors; (iii) cystic lesions; and (iv) infectious and inflammatory conditions.Classical midline anomalies like septo-optic dysplasias or corpus callosum agenesis are commonly associated with pituitary endocrinopathies and also need careful evaluation.In this radiological review, we will discuss neuroendocrine disorders related to hypothalamic pituitary-axis.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis, Employees' State Insurance Corporation (ESIC) Model Hospital, Gurgaon, Haryana, India.

ABSTRACT
Accurate investigation of the hypothalamic-pituitary area is required in pediatric patients for diagnosis of endocrine-related disorders. These disorders include hypopituitarism, growth failure, diencephalic syndrome, delayed puberty, precocious puberty, diabetes insipidus, syndrome of inappropriate antidiuretic hormone (SIADH) secretion, and hyperpituitarism. Magnetic resonance imaging (MRI) is the modality of choice to visualize hypothalamic-pituitary axis and associated endocrinopathies. Neuroimaging can be normal or disclose abnormalities related to pituitary-hypothalamic axis like (i) congenital and developmental malformations; (ii) tumors; (iii) cystic lesions; and (iv) infectious and inflammatory conditions. Classical midline anomalies like septo-optic dysplasias or corpus callosum agenesis are commonly associated with pituitary endocrinopathies and also need careful evaluation. In this radiological review, we will discuss neuroendocrine disorders related to hypothalamic pituitary-axis.

No MeSH data available.


Related in: MedlinePlus