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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 macroadenoma: Axial T2W (a) and T1W (b) images show a large inhomogeneous, isointense pituitary mass (arrow), encroaching bilateral cavernous sinus regions. On postcontrast coronal (c) and sagittal (d) images, the lesion exhibits moderate contrast enhancement. Left internal carotid artery (cavernous part) appears to be displaced laterally by the mass, while the right internal carotid artery is seen traversing through the mass, thereby showing invasion of ipsilateral cavernous sinus. However, both the arteries demonstrate normal contrast opacification with mild luminal compromise. Stereotactic biopsy proved pituitary macroadenoma. [Reproduced with permission from Indian Journal of Endocrinology and Metabolism]
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Figure 6: Pituitary macroadenoma: Axial T2W (a) and T1W (b) images show a large inhomogeneous, isointense pituitary mass (arrow), encroaching bilateral cavernous sinus regions. On postcontrast coronal (c) and sagittal (d) images, the lesion exhibits moderate contrast enhancement. Left internal carotid artery (cavernous part) appears to be displaced laterally by the mass, while the right internal carotid artery is seen traversing through the mass, thereby showing invasion of ipsilateral cavernous sinus. However, both the arteries demonstrate normal contrast opacification with mild luminal compromise. Stereotactic biopsy proved pituitary macroadenoma. [Reproduced with permission from Indian Journal of Endocrinology and Metabolism]

Mentions: Prolactinomas are the most common pituitary adenomas in older children and adolescents, with a female preponderance. They may be seen associated with MEN 1 or may occur as familial isolated pituitary adenomas. Prolactinomas can present as a small intrasellar mass lesion measuring <1 cm (microadenoma) or as a large sellar–suprasellar mass measuring > 1 cm (macroadenoma) in size.[3637] Pituitary macroadenomas with a large sellar/suprasellar component may impinge on optic nerves and/or optic chiasma to produce visual field abnormalities or invade cavernous sinus producing symptoms and signs related to involvement of cranial nerves (3rd, 4th and 6th cranial nerves, as well as 1st and 2nd divisions of the 5th cranial nerve) that run in the cavernous sinus. Macroadenomas may also extend inferiorly into the sphenoid producing remodeling of bone or may be seen invading skull base and infratemporal fossa structures.[38] On MRI [Figure 6], macroadenomas may be homogenous or heterogeneous in signal intensity with areas of hemorrhage, cyst formation or necrosis. A significant hemorrhage with necrosis in an adenoma can produce the syndrome of pituitary apoplexy [Figure 7]. Remodeling and enlargement of sella is usually seen associated with large macroadenomas.[3839] The symptoms due to a prolactinoma are broadly divided into those that are caused by increased prolactin levels and others that are caused by mass effect. Those that are caused by increased prolactin levels are amenorrhoea/galactorrhea in females, hypogonadism, gynecomastia and erectile dysfunction in males, and loss of axillary/pubic hair; while, those that are caused by mass effect are bitemporal hemianopsia (due to pressure on optic chiasma), vertigo, nausea, and vomiting.[40] Pituitary apoplexy is characterized by clinical findings of sudden onset headache usually associated with visual disturbance.[41]


Imaging of pediatric pituitary endocrinopathies.

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

Pituitary macroadenoma: Axial T2W (a) and T1W (b) images show a large inhomogeneous, isointense pituitary mass (arrow), encroaching bilateral cavernous sinus regions. On postcontrast coronal (c) and sagittal (d) images, the lesion exhibits moderate contrast enhancement. Left internal carotid artery (cavernous part) appears to be displaced laterally by the mass, while the right internal carotid artery is seen traversing through the mass, thereby showing invasion of ipsilateral cavernous sinus. However, both the arteries demonstrate normal contrast opacification with mild luminal compromise. Stereotactic biopsy proved pituitary macroadenoma. [Reproduced with permission from Indian Journal of Endocrinology and Metabolism]
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475890&req=5

Figure 6: Pituitary macroadenoma: Axial T2W (a) and T1W (b) images show a large inhomogeneous, isointense pituitary mass (arrow), encroaching bilateral cavernous sinus regions. On postcontrast coronal (c) and sagittal (d) images, the lesion exhibits moderate contrast enhancement. Left internal carotid artery (cavernous part) appears to be displaced laterally by the mass, while the right internal carotid artery is seen traversing through the mass, thereby showing invasion of ipsilateral cavernous sinus. However, both the arteries demonstrate normal contrast opacification with mild luminal compromise. Stereotactic biopsy proved pituitary macroadenoma. [Reproduced with permission from Indian Journal of Endocrinology and Metabolism]
Mentions: Prolactinomas are the most common pituitary adenomas in older children and adolescents, with a female preponderance. They may be seen associated with MEN 1 or may occur as familial isolated pituitary adenomas. Prolactinomas can present as a small intrasellar mass lesion measuring <1 cm (microadenoma) or as a large sellar–suprasellar mass measuring > 1 cm (macroadenoma) in size.[3637] Pituitary macroadenomas with a large sellar/suprasellar component may impinge on optic nerves and/or optic chiasma to produce visual field abnormalities or invade cavernous sinus producing symptoms and signs related to involvement of cranial nerves (3rd, 4th and 6th cranial nerves, as well as 1st and 2nd divisions of the 5th cranial nerve) that run in the cavernous sinus. Macroadenomas may also extend inferiorly into the sphenoid producing remodeling of bone or may be seen invading skull base and infratemporal fossa structures.[38] On MRI [Figure 6], macroadenomas may be homogenous or heterogeneous in signal intensity with areas of hemorrhage, cyst formation or necrosis. A significant hemorrhage with necrosis in an adenoma can produce the syndrome of pituitary apoplexy [Figure 7]. Remodeling and enlargement of sella is usually seen associated with large macroadenomas.[3839] The symptoms due to a prolactinoma are broadly divided into those that are caused by increased prolactin levels and others that are caused by mass effect. Those that are caused by increased prolactin levels are amenorrhoea/galactorrhea in females, hypogonadism, gynecomastia and erectile dysfunction in males, and loss of axillary/pubic hair; while, those that are caused by mass effect are bitemporal hemianopsia (due to pressure on optic chiasma), vertigo, nausea, and vomiting.[40] Pituitary apoplexy is characterized by clinical findings of sudden onset headache usually associated with visual disturbance.[41]

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