3T MRI of the pituitary gland was performed on 274 patients,
mostly due to hormonal disorders.
Patient’s age ranged from 8-70y.,
mean age 39y.
71% were females.
The laboratory findings were most commonly high prolactin levels presenting with irregular and painful periods,
inability to conceive,
headaches,
painful breasts.
High somatotropin levels showed symptoms of Acromegaly.
Patients with hypopituitarism features as well as hypogonadism were also examined.
MR examination was carried out on a 3T MAGNETOM Verio Machine.
The images were analyzed on a Syngo viewer workstation.
The protocol included as follows:
- axial T2 as an overview sequence to exclude any accompanying or incidental brain pathologies
- T1,
T2 sagittal and coronal images were obtained precontrast to evaluate the pituitary gland.
- A dynamic postcontrast series as well as a delayed phase were performed in coronal plane to assess structural changes in the gland.
- Contrast medium used was Gadolinium 0.1mmol/kg in respect with optimal creatinine levels.
Results:
In 1% of the patients the typical T1 bright spot of the neurohypophysis was not found on its anatomical place.
Those patients presented with various pituitary impairment.
Patient №1
18y.o.
female,
diagnosed in infancy with hypopituitarism,
due to short stature accompanied with delayed puberty,
primary amenorrhea and lack of secondary sex signs.
Current laboratory tests revealed low levels of growth hormone,
TSH,
Luteinizing hormone,
and estradiol.
Our patient was born from a second pathologically carried pregnancy and in a breech position and had suffered hypoxia.
MRI revealed T1 bright spot of posterior pituitary located right next to the optic chiasm.
A small adenohypophysis was founds.
No pituitary stalk was observed.
Patient №2
45y.o.
female.
She had transphenoidal adenomectomy 3 years prior performed due to a secreting ACTH tumour.
At the time of the surgery she had presented with Cushing symptoms – obesities,
round Moon face,
edema in the lower extremities,
stretch marks.
Laboratory findings were consistent with ACTH adenoma of the pituitary – high ACTH and cortisol levels after Corticotropin releasing factor (CRF) test.
On the follow up MRI 3y.
later,
a small part of the adenohypophysis was left.
At the distal part of the infundibulum T1 bright spot was seen.
On the coronal images the optic chiasm was not seen in the horizontal line as normal.
The findings was interpreted as an EN with postoperative changes.
The case was ruled out as an iatrogenic cause of EN.
The patient’s current complaints were diabetes insipidus.
Patient №3
26y.o.
male.
Suffering from short stature,
hypogonadism,
endocrinological findings showed panhypopituitarism.
MRI revealed hypoplasia of the adenohypophysis,
lack in infundibulum and posterior T1 bright spot of the neurohypophysis was seen at the median eminence.