Audit on isolated pituitary stalk lesions/thickening in a tertiary hospital: Comprehensive guidelines needed

Research output: Contribution to conference (unpublished)Posterpeer-review

Colleges, School and Institutes

Abstract

Background
Isolated pituitary stalk (PS) lesions/thickening detected on imaging pose
challenging dilemmas.

Aim
Audit the diagnostic approach and management of patients with isolated PS
lesions/thickening reported on MRI in a tertiary hospital.

Methods
Reports of pituitary/brain MRIs performed in our Radiology Department between
1/2013 and 12/2015 were searched for the terms ‘stalk’, ‘infundibular’,
‘infundibulum’. Those with abnormality not limited to the stalk and cases with
previous pituitary surgery were excluded.

Results
Fifteen cases were identified (nine females, median age 48 years; range 19–91)
managed by various specialists. Reasons for MRI: possible diabetes insipidus
(nZ3), hyperprolactinaemia (nZ2), history of hypopituitarism (nZ1), neurosarcoidosis (nZ1), anaplastic lymphoma (nZ1), spinal ependymoma (nZ1),
investigation of other symptoms/signs (nZ6;incidental finding).
Pituitary function FSH/LH deficient 4/15, normal 5/15, not checked 6/15; hyperprolactinaemia 4/15 (resolved in 2), normal 5/15, not checked 6/15; ACTH normal 9/15, not checked 6/15 (one on steroids); TSH deficiency 4/15, normal 10/15, not checked 1/15;diabetes insipidus 2/15. No patient had stalk biopsy. Diagnoses were hypophysitis (nZ2; based on imaging findings and later reduction of lesion), neurosarcoidosis (nZ2; based on previous history and biopsy of other lesions), presumed Langerhans cell histiocytosis (nZ1; diagnosed 8 years later from a skin lesion-remained stable during this interval), presumed Rathke’s cleft cyst (nZ1; no further follow-up deemed necessary), presumed metastasis from ependymona (nZ1), progression of anaplastic lymphoma (nZ1). Diagnosis was not clarified in 6 cases with stable imaging appearances (median follow-up 8 months (2–24)); their documented investigations included chest imaging nZ3/6, vasculitis screen/aFP/hGC/inflammatory markers nZ2/6, FDG-PET-CT nZ1/6. In one
case, further review was suggestive of ‘normal variation’ and had no further
scans. Conclusions: Given that biopsy of isolated PS lesions/thickening is
technically demanding, previous history, clinical/laboratory evaluation may
narrow the diagnosis. However, in a number of cases, diagnosis is not established and investigations arranged seem to be non-comprehensive. As their natural history remains poorly understood, a robust diagnostic and management algorithm will guide all clinicians involved.

Details

Original languageEnglish
Publication statusPublished - Nov 2016
EventSociety for Endocrinology BES 2016 - Brighton, United Kingdom
Duration: 7 Nov 20169 Nov 2016

Conference

ConferenceSociety for Endocrinology BES 2016
CountryUnited Kingdom
CityBrighton
Period7/11/169/11/16