Pituitary gland: beyond adenomas

This poster is published under an open license. Please read the disclaimer for further details.

Congress:

ECR 2017

Poster Number:

C-2421

Type:

Educational Exhibit

Keywords:

Pathology, Education, MR, CT, Neuroradiology brain, CNS

Authors:

J. I. Muñoz López¹, A. Hernández Villegas², B. Riveros Gilardi³, M. Santoscoy⁴, J. A. Gabutti⁵, A. Garay⁶, J. Rubalcava Ortega⁵, J. Higuera⁵; ¹México D.F. /MX, ²Tlalpan, México DF/MX, ³Mexico City/MX, ⁴Guadalaja /MX, ⁵México D.F./MX, ⁶San Luis Potosi /MX

DOI:

10.1594/ecr2017/C-2421

DOI-Link:

https://dx.doi.org/10.1594/ecr2017/C-2421

Fig. 3: T1 weighted contrast enhanced, intrasellar, intraglandular lesion, less than 1...

Fig. 4: T1 without contrast shows intra and suprasellar lesion bigger than 1 cm with...

Fig. 5: Same patient as in figure 2 shows the lesion with contrast material which...

Fig. 8: Pituitary apoplexy. T1 shows a hyperintense, round, well defined lesion in the...

Learning objectives

The purpose of this educational exhibit is to review imaging findings of lesions of the pituitary gland looking beyond adenomas, based on interesting cases that highlight features of different pathology. Pearls and pitfalls for accurate assessment are provided in relevant situations.

Background

The sella turcica houses the pituitary gland in a midline, shallow depression in the posterior sphenoid bone. Its appearance is variable and depends on the pneumatization of the underlying sphenoid sinus as they may merge on MR images. The optic chiasm lies anterior to the infundibulum and visual field deficits are signs of pituitary axis dysfunction. The pituitary gland arises from two separate sources: the posterior lobe (or neurohypophysis) and the anterior lobe (adenohypophysis). The posterior lobe is a downward extension of the hypothalamus while...

Findings and procedure details

Appropriate evaluation of the pituitary gland requires knowledge of the normal and its variants. While in young children the gland has an upwards convex shape, in adults is flat. Glandular height more than in 8 mm in males and 9 mm in women is rare under normal circumstances, the infundibular diameter is less than 3 mm. There is a physiologic size increase of approximately 0.08 mm per week during pregnancy but it rearly exceeds 10 mm, the maximum diameter achived immediately postpartum and recovery within...

Conclusion

The pituitary gland is a complex and specialized organ that requires knowledge of specific imaging characteristics that can be useful in the diagnosis of a lesion. Understanding biological behaviour, optimizing MRI scanning parameters and knowing the relevant clinical information that can aid in the diferential is paramount to a more narrow and precise diagnosis.

Personal information

E-mail: [email protected] Mexico City, Mexico.

References

1.Buchfelder M, Schlaffer S. Imaging of pituitary patolology. Handb Clin Neurol. 2014;124:151-66. 2.Rennert J, Doerfler A. Imaging of sellar and parasellar lesions. Clin Neurol Neurosurg. 2007 Feb;109(2):111-24. 3.Lucas JW, Zada G. Imaging of the pituitary and parasellar region. Semin Neurol. 2012 Sep;32(4):320-31. 4.Hess CP, Dillon WP. Imaging the pituitary and parasellar region. Neurosurg Clin N Am. 2012 Oct;23(4):529-42. 5.Pisaneschi M, Kapoor G. Imaging the sella and parasellar region. Neuroimaging Clin N Am. 2005 Feb;15(1):203-19. 6.Saeger W, Ludecke DK, Buchfelder M, Fahlbusch R, Quabbe HJ, Petersenn...