PITUITARY STALK TRANSECTION SYNDROME : A LATE REVELATION
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Transcript of PITUITARY STALK TRANSECTION SYNDROME : A LATE REVELATION
S BOUABIDI ,S JERBI OMEZZINE , Z KHADIMALLAH, K BOUSLEMA, B ZANTOUR* H A HAMZA
Department of Medical Imaging, Tahar Sfar University Hospital Center Mehdia, Tunisia
*Department of Internal Medecine, Tahar Sfar University Hospital Center Mehdia, Tunisia
PITUITARY STALK TRANSECTION SYNDROME : A LATE REVELATION
NR12
INTRODUCTIONGrowth hormone deficiency is a common endocrinologic cause of short stature:
Idiopathic Associated with organic causes( tumors , surgery)
Pituitary stalk transection is a non-negligible cause of growth hormone (GH) deficiency
Multifaceted presentation in childhood
MRI: • Imaging modality of choice • Anatomic details Study of the pituitary- hypothalamic region• Pathognomonic findings
We report the case of a 20 year old male to illustrate the particularities of late revelation of this syndrome
Patients and Methods:A 20 year old male Growth retardationPast history: No foetal distress No cranial trauma
Biological assessment, Anterior pituitary function exploration
Brain MRI were performed
Results:Biological assessment: No kind of misabsorption
Anterior pituitary function exploration: GH and Gonadotropin deficiency
MRI: Hypoplasia of the anterior hypophysis
Absence of pituitary stalk
Ectopic posterior hypophysis
Gadolinium-enhanced coronal T1-weighted MR images : The pituitary stalk is not visibile (arrow)
Gadolinium-enhanced coronal T1-weighted MR images: Ectopic posterior pituitary gland (arrow) which is seen as an area of high signal intensity in the midline
Unenhanced midline sagittal T1-weighted MR image shows the small anterior pituitary gland (short arrow) and ectopic posterior pituitary gland (long arrow)
DISCUSSION:Isolated growth hormone deficiency and multiple pituitary hormone deficiency can be part of the pituitary stalk transection syndrome
The pituitary stalk transection syndrome should be considered in patients who were previously thought to have idiopathic GH deficiency or multiple pituitary hormone deficiencies
Magnetic resonance imaging (MRI) :
The diagnostic method of choice for idiopathic hypopituitarismExcellent definition of the hypothalamic pituitary region Gadolinium injection is necessary for a better description of the stalk
Imaging characteristics of this syndrome :
Lack of pituitary stalk visibility ( after injection of a gadolinium-enhanced contrast ) Hypoplasia of the anterior hypophysis Ectopic posterior pituitary gland
Anatomical variations in the location of the high intensity signal of the posterior pituitary seen on T1-weighted MRI may occur infrequently and have to be differentiated from a stalk-located lipoma
Presence of MRI characteristics compatible with the pituitary stalk transection syndrome should prompt a full pituitary hormonal evaluation
Patients require regular clinical survey and hormonal controlsProgression to complete anterior pituitary hormone deficiency may occur, even during the 2nd or the 3rd decade of life
CONCLUSION:
Stalk transaction syndrome :Relatively frequent should be considered in patients who were previously thought to have idiopathic GH deficiency or pituitary hormone deficiencyMRI :the diagnostic method of choice showing pathognomonic characteristicsRequire regular clinical survey and hormonal controls