Hypopituitarism MRI: Difference between revisions

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{{Hypopituitarism}}
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==Overview==
==Overview==
MRI is the imaging procedure of choice in the diagnosis of hypopituitarism. It is preferred over the CT scan as optic chiasm, pituitary stalk, and cavernous sinuses can be seen in MRI. An MRI lesion needs to be related to clinical and lab findings. The absence of an MRI lesion mostly indicates a non-organic etiology.
[[Magnetic resonance imaging|MRI]] is the imaging procedure of choice in the diagnosis of [[Hypopituitarism (patient information)|hypopituitarism]]. It is preferred over the [[CT scan]] as [[optic chiasm]], [[pituitary stalk]], and [[cavernous sinuses]] can be seen in [[Magnetic resonance imaging|MRI]]. An [[Magnetic resonance imaging|MRI]] lesion needs to be related to clinical and lab findings. The absence of an [[Magnetic resonance imaging|MRI lesion]] mostly indicates a non-organic etiology. [[Cystic]] lesions, such as [[Rathke's pouch|Rathke's cleft]] cysts may have a low-intensity signal on T1-weighted images and a high-intensity signal on T2-weighted images. [[Meningiomas]] have a [[homogenous]] postcontrast enhancement than [[Pituitary adenoma|pituitary adenomas]] and have a [[suprasellar]] attachment. [[Hemorrhage]] into the [[pituitary gland]] results in a high-intensity signal on both T1- and T2-weighted images.


==MRI==
==MRI==
*MRI is the imaging procedure of choice in diagnosis of hypopituitarism. It is preferred over the CT scan as optic chiasm, pituitary stalk, and cavernous sinuses can be seen in MRI.<ref name="Vance1994">{{cite journal|last1=Vance|first1=Mary Lee|title=Hypopituitarism|journal=New England Journal of Medicine|volume=330|issue=23|year=1994|pages=1651–1662|issn=0028-4793|doi=10.1056/NEJM199406093302306}}</ref>  
*[[Magnetic resonance imaging|MRI]] scan with [[intravenous]] [[gadolinium]] is the imaging procedure of choice in the [[diagnosis]] of [[hypopituitarism|hypopituitarism.]] It is preferred over the [[CT scan]] as [[optic chiasm]], [[pituitary stalk]], and [[cavernous sinuses]] can be seen in [[Magnetic resonance imaging|MRI]]<ref name="Vance1994">{{cite journal|last1=Vance|first1=Mary Lee|title=Hypopituitarism|journal=New England Journal of Medicine|volume=330|issue=23|year=1994|pages=1651–1662|issn=0028-4793|doi=10.1056/NEJM199406093302306}}</ref>  
*MRI is the single best imaging modality in the evaluation of sellar masses as certain findings are suggestive of some specific sellar masses and help to differentiaite them
*[[Magnetic resonance imaging|MRI]] is the single best [[imaging]] [[modality]] in the evaluation of [[Sella|sellar]] masses as certain findings are suggestive of some specific [[Sella turcica|sellar]] masses and help to [[differentiate]] them
*A magnetic resonance imaging (MRI) scan may show a three-dimensional image of [[pituitary gland]], [[hypothalamus]], and the organs near them.
*If [[MRI]] is not possible due to any reason, high-resolution [[CT scan]] with [[contrast]] administration, in [[coronal plane]], may be used as an alternative
*MRI is used to detect the underlying cause of hypopituitarism like the pituitary adenoma that can be seen as a mass with hormonal hypersecretion.
*An [[magnetic resonance imaging]] ([[Magnetic resonance imaging|MRI]]) scan may show a three-dimensional [[image]] of [[pituitary gland]], [[hypothalamus]], and the surrounding intracranial structures
*There is a positive correlation between MRI findings and the number of pituitary hormonal deficiencies.<ref name="pmid20197674">{{cite journal |vauthors=Li G, Shao P, Sun X, Wang Q, Zhang L |title=Magnetic resonance imaging and pituitary function in children with panhypopituitarism |journal=Horm Res Paediatr |volume=73 |issue=3 |pages=205–9 |year=2010 |pmid=20197674 |doi=10.1159/000284363 |url=}}</ref><ref name="pmid21646285">{{cite journal |vauthors=Child CJ, Zimmermann AG, Woodmansee WW, Green DM, Li JJ, Jung H, Erfurth EM, Robison LL |title=Assessment of primary cancers in GH-treated adult hypopituitary patients: an analysis from the Hypopituitary Control and Complications Study |journal=Eur. J. Endocrinol. |volume=165 |issue=2 |pages=217–23 |year=2011 |pmid=21646285 |pmc=3132593 |doi=10.1530/EJE-11-0286 |url=}}</ref>
*[[Magnetic resonance imaging|MRI]] is used to detect the underlying cause of [[pituitary adenoma]] that can be seen as a mass with [[hormonal]] hypersecretion
*An MRI lesion needs to be related to clinical and lab findings. The absence of an MRI lesion mostly indicates a non-organic etiology.
*There is a positive [[correlation]] between [[Magnetic resonance imaging|MRI]] <nowiki/>findings and the number of [[Pituitary hormone|pituitary hormonal]] deficiencies<ref name="pmid20197674">{{cite journal |vauthors=Li G, Shao P, Sun X, Wang Q, Zhang L |title=Magnetic resonance imaging and pituitary function in children with panhypopituitarism |journal=Horm Res Paediatr |volume=73 |issue=3 |pages=205–9 |year=2010 |pmid=20197674 |doi=10.1159/000284363 |url=}}</ref><ref name="pmid21646285">{{cite journal |vauthors=Child CJ, Zimmermann AG, Woodmansee WW, Green DM, Li JJ, Jung H, Erfurth EM, Robison LL |title=Assessment of primary cancers in GH-treated adult hypopituitary patients: an analysis from the Hypopituitary Control and Complications Study |journal=Eur. J. Endocrinol. |volume=165 |issue=2 |pages=217–23 |year=2011 |pmid=21646285 |pmc=3132593 |doi=10.1530/EJE-11-0286 |url=}}</ref>
*MRI scan shows the following findings in cases of hypopituitarism:<ref name="Pozzi MucelliFrezza1992">{{cite journal|last1=Pozzi Mucelli|first1=R. S.|last2=Frezza|first2=F.|last3=Magnaldi|first3=S.|last4=Proto|first4=G.|title=Magnetic resonance imaging in patients with panhypopituitarism|journal=European Radiology|volume=2|issue=1|year=1992|pages=42–46|issn=0938-7994|doi=10.1007/BF00714180}}</ref>  
*An [[MRI]] lesion needs to be related to clinical and lab findings. The absence of an [[Magnetic resonance imaging|MRI]] lesion mostly indicates a non-organic [[etiology]]
**Decreased size of the pituitary gland.
*[[Magnetic resonance imaging|MRI]] <nowiki/>scan may show the following findings in cases of [[hypopituitarism]]:<ref name="Pozzi MucelliFrezza1992">{{cite journal|last1=Pozzi Mucelli|first1=R. S.|last2=Frezza|first2=F.|last3=Magnaldi|first3=S.|last4=Proto|first4=G.|title=Magnetic resonance imaging in patients with panhypopituitarism|journal=European Radiology|volume=2|issue=1|year=1992|pages=42–46|issn=0938-7994|doi=10.1007/BF00714180}}</ref>  
**Empty sella may be noticed in some cases.
**Decreased size of the [[pituitary gland]]
**Pituitary stalk may be visible, thin, or totally absent.
**[[Empty sella]] may be noticed in some cases  
**Posterior lobe of the pituitary may be absent.
**[[Pituitary stalk]] may be visible, thin, or totally absent  
**Mass may appear in the pituitary.
**[[Posterior lobe]] of the [[pituitary]] may be absent
**Ectopic posterior lobe of the pituitary gland may be observed in cases of pituitary dwarfism.  
**Mass may appear in the [[pituitary]]
**[[Ectopic]] [[posterior lobe]] of the [[pituitary gland]] may be observed in cases of [[Pituitary dwarfism II|pituitary dwarfism]]
**Infiltrative disorders such a [[sarcoidosis]] and [[histiocytosis]] may present as thickening of infundibulum<ref name="pmid22015494">{{cite journal |vauthors=Imashuku S, Kudo N, Kaneda S, Kuroda H, Shiwa T, Hiraiwa T, Inagaki A, Morimoto A |title=Treatment of patients with hypothalamic-pituitary lesions as adult-onset Langerhans cell histiocytosis |journal=Int. J. Hematol. |volume=94 |issue=6 |pages=556–60 |year=2011 |pmid=22015494 |doi=10.1007/s12185-011-0955-z |url=}}</ref>
**In [[central DI]], T1 weighted MR shows absence of high internsity bright spot that is normally seen in [[Posterior pituitary gland|posterior pituitary]]<ref name="pmid7625990">{{cite journal |vauthors=De Herder WW, Lamberts SW |title=Imaging of pituitary tumours |journal=Baillieres Clin. Endocrinol. Metab. |volume=9 |issue=2 |pages=367–89 |year=1995 |pmid=7625990 |doi= |url=}}</ref>


* Cystic lesions, such as Rathke's cleft cysts may have
* Cystic lesions, such as [[Rathke's pouch|Rathke's cleft]] cysts may have
** a low-intensity signal on T1-weighted images
** A low-intensity signal on T1-weighted images
** a high-intensity signal on T2-weighted images
** A high-intensity signal on T2-weighted images


* Meningiomas have a homogenous postcontrast enhancement than pituitary adenomas and have a suprasellar attachment.<ref name="pmid1407446">{{cite journal |vauthors=Taylor SL, Barakos JA, Harsh GR, Wilson CB |title=Magnetic resonance imaging of tuberculum sellae meningiomas: preventing preoperative misdiagnosis as pituitary macroadenoma |journal=Neurosurgery |volume=31 |issue=4 |pages=621–7; discussion 627 |year=1992 |pmid=1407446 |doi= |url=}}</ref>
* [[Meningiomas]] have a [[homogenous]] postcontrast enhancement than [[pituitary adenomas]] and have a [[suprasellar]] attachment<ref name="pmid1407446">{{cite journal |vauthors=Taylor SL, Barakos JA, Harsh GR, Wilson CB |title=Magnetic resonance imaging of tuberculum sellae meningiomas: preventing preoperative misdiagnosis as pituitary macroadenoma |journal=Neurosurgery |volume=31 |issue=4 |pages=621–7; discussion 627 |year=1992 |pmid=1407446 |doi= |url=}}</ref>
* Hemorrhage into the pituitary gland results in a high-intensity signal on both T1- and T2-weighted images.
* [[Hemorrhage]] into the [[pituitary gland]] results in a high-intensity signal on both T1- and T2-weighted images


===Ectopic posterior lobe of the pituitary gland===
[[ File:Empty sella gif.gif |thumb|left|350px|Empty Sella. Source: Wikimedia Commons<ref name="urlFile:Empty Sella MRT FLAIR sag 001.jpg - Wikimedia Commons">{{cite web |url=https://commons.wikimedia.org/wiki/File:Empty_Sella_MRT_FLAIR_sag_001.jpg |Hellerhoff |title=File:Empty Sella MRT FLAIR sag 001.jpg - Wikimedia Commons |format= |work= |accessdate=}}</ref>]]
MRI scan in cases of ectopic posterior lobe shows the following:<ref name="pmid12372734">{{cite journal| author=Mitchell LA, Thomas PQ, Zacharin MR, Scheffer IE| title=Ectopic posterior pituitary lobe and periventricular heterotopia: cerebral malformations with the same underlying mechanism? | journal=AJNR Am J Neuroradiol | year= 2002 | volume= 23 | issue= 9 | pages= 1475-81 | pmid=12372734 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12372734  }} </ref>  
 
*Abscence of the posterior pituitary bright spot
<br style="clear:left" />
*High T1 signal 3-8-mm tissue nodule at the median eminence (floor of third ventricle)
 
[[File:Pituitary-macroadenoma-necrotic-1marked reduced.jpg|center|MRI showing necrotic pituitary adenoma (Source: Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 17664)|frame]]
 
==Gallery==
 
<gallery>
 
Image:Pituitary-macroadenoma-MR-T1-axial-post-01.jpg|There is a well defined round lesion noted in the pituitary fossa, the lesion shows homogeneous contrast enhancement.<ref name=radio> Case contributed by Radswiki [http://www.radiopaedia.org Radiopaedia](original file [http://radiopaedia.org/cases/pituitary-adenoma ‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>
 
Image:Pituitary-macroadenoma-MR-T1-sag-01.jpg|There is a well defined round lesion noted in the pituitary fossa, the lesion is homogeneous and isodense on T1.<ref name=radio> Case contributed by Radswiki [http://www.radiopaedia.org Radiopaedia](original file [http://radiopaedia.org/cases/pituitary-adenoma ‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>
 
</gallery>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
 
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Latest revision as of 22:19, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2] Iqra Qamar M.D.[3]

Overview

MRI is the imaging procedure of choice in the diagnosis of hypopituitarism. It is preferred over the CT scan as optic chiasm, pituitary stalk, and cavernous sinuses can be seen in MRI. An MRI lesion needs to be related to clinical and lab findings. The absence of an MRI lesion mostly indicates a non-organic etiology. Cystic lesions, such as Rathke's cleft cysts may have a low-intensity signal on T1-weighted images and a high-intensity signal on T2-weighted images. Meningiomas have a homogenous postcontrast enhancement than pituitary adenomas and have a suprasellar attachment. Hemorrhage into the pituitary gland results in a high-intensity signal on both T1- and T2-weighted images.

MRI

  • Cystic lesions, such as Rathke's cleft cysts may have
    • A low-intensity signal on T1-weighted images
    • A high-intensity signal on T2-weighted images
Empty Sella. Source: Wikimedia Commons[8]


MRI showing necrotic pituitary adenoma (Source: Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 17664)

Gallery

  • There is a well defined round lesion noted in the pituitary fossa, the lesion shows homogeneous contrast enhancement.[9]

    There is a well defined round lesion noted in the pituitary fossa, the lesion shows homogeneous contrast enhancement.[9]

  • There is a well defined round lesion noted in the pituitary fossa, the lesion is homogeneous and isodense on T1.[9]

    There is a well defined round lesion noted in the pituitary fossa, the lesion is homogeneous and isodense on T1.[9]

References

  1. ↑ Vance, Mary Lee (1994). "Hypopituitarism". New England Journal of Medicine. 330 (23): 1651–1662. doi:10.1056/NEJM199406093302306. ISSN 0028-4793.
  2. ↑ Li G, Shao P, Sun X, Wang Q, Zhang L (2010). "Magnetic resonance imaging and pituitary function in children with panhypopituitarism". Horm Res Paediatr. 73 (3): 205–9. doi:10.1159/000284363. PMID 20197674.
  3. ↑ Child CJ, Zimmermann AG, Woodmansee WW, Green DM, Li JJ, Jung H, Erfurth EM, Robison LL (2011). "Assessment of primary cancers in GH-treated adult hypopituitary patients: an analysis from the Hypopituitary Control and Complications Study". Eur. J. Endocrinol. 165 (2): 217–23. doi:10.1530/EJE-11-0286. PMC 3132593. PMID 21646285.
  4. ↑ Pozzi Mucelli, R. S.; Frezza, F.; Magnaldi, S.; Proto, G. (1992). "Magnetic resonance imaging in patients with panhypopituitarism". European Radiology. 2 (1): 42–46. doi:10.1007/BF00714180. ISSN 0938-7994.
  5. ↑ Imashuku S, Kudo N, Kaneda S, Kuroda H, Shiwa T, Hiraiwa T, Inagaki A, Morimoto A (2011). "Treatment of patients with hypothalamic-pituitary lesions as adult-onset Langerhans cell histiocytosis". Int. J. Hematol. 94 (6): 556–60. doi:10.1007/s12185-011-0955-z. PMID 22015494.
  6. ↑ De Herder WW, Lamberts SW (1995). "Imaging of pituitary tumours". Baillieres Clin. Endocrinol. Metab. 9 (2): 367–89. PMID 7625990.
  7. ↑ Taylor SL, Barakos JA, Harsh GR, Wilson CB (1992). "Magnetic resonance imaging of tuberculum sellae meningiomas: preventing preoperative misdiagnosis as pituitary macroadenoma". Neurosurgery. 31 (4): 621–7, discussion 627. PMID 1407446.
  8. ↑ "File:Empty Sella MRT FLAIR sag 001.jpg - Wikimedia Commons". Text "Hellerhoff " ignored (help)
  9. ↑ 9.0 9.1 Case contributed by Radswiki Radiopaedia(original file ‘’here’’).Creative Commons BY-SA-NC

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