Category: Pituitary Disorders/Neuroendocrinology

Monitor: 32

32 - LONG-TERM FOLLOW-UP IN A SERIES OF PITUITARY STALK LESIONS

Thursday, Apr 25
11:00 AM – 11:30 AM

Objective :

Pituitary stalk (PS) lesions may arise from the stalk itself or from pathological processes involving the pituitary or hypothalamus. They may have neoplastic, inflammatory, infectious, or congenital etiologies. The diagnosis of PS lesions is difficult, and remains unknown in 40-50% of cases.  We describe 8 cases with PS lesions and long-term follow-up.


Methods : A retrospective search of the patients'  files between 2005 – 2018.


Results :

5 women and 3 men with PS lesions, age at diagnosis 18-71  years (median 28 years), 6 of them with a mean follow-up of 7.5 years (4 – 13 years); 6 patients presented with diabetes insipidus and 1 with potophilia, 6 had anterior pituitary insufficiency at diagnosis, 1 patient was diagnosed with panhypopituitarism 10 years after diagnosis. In 5 cases a hypothalamic –pituitary infiltrative lesion was described on CT/MRI: 1 patient had systemic lupus erythematosus, 1 had concomitant pansinusitis with etmoidal sinusitis and unilateral paresis of abducens nerve; treatment with systemic glucocorticoids was associated with remission of the mass in both patients and remission of the nerve paresis. Spontaneous reduction of the lesion was seen in 1 patient, followed by hypopituitarism, both diagnosed 10 years after the initial evaluation. In the 4th patient a diagnosis of hypophysitis was suggested, she had hypopituitarism, depressive symptoms and 2 short episodes of loss of conscience; the sellar mass had a small reduction on glucocorticoid replacement therapy. In 1 patient a nodular hourglass-like mass was described in the PS and pituitary, stable for 4 years, then after an acute episode suggesting pituitary apoplexy she underwent surgery and the diagnosis was germ cell tumor.  In 3 patients a small PS mass was described, stable during 6 years of FU in 1 case and with 2 mm increase during 4 years FU in 1 case. Imaging and blood tests excluded germ cell tumors, sarcoidosis or hystiocytosis in these cases.


Discussion : Despite extensive evaluation, the etiological diagnosis was made only in 25% of cases  (1 lupus hypophysitis and 1 germ cell tumor). In none of the patients was attended a biopsy of the lesion.


Conclusion :

Pituitary stalk lesions, mostly inflammatory or neoplastic in the adult, are rare and usually associated with diabetes insipidus and hypopituitarism. The etiologic diagnosis remains a challenge, and long-term follow-up is needed. In some cases systemic glucocorticoid treatment was associated with remission of the visible lesion.

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Monica Livia Gheorghiu

Endocrinologist
Carol Davila University of Medicine and Pharmacy, C.I. Parhon National Institute of Endocrinology, Bucharest
Bucuresti, Bucuresti, Romania

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Sofia Maria Lider Burciulescu

Resident
C.I. Parhon National Institute of Endocrinology, Bucharest

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Anda Dumitrascu

Senior Radiologist
C.I. Parhon National Institute of Endocrinology, Bucharest, Romania

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Dan Hortopan

Senior Radiologist
C.I. Parhon National Institute of Endocrinology, Bucharest
Bucuresti, Bucuresti, Romania

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Virgil Ionescu

Senior Radiologist
Sanador Clinic, Bucharest

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Andra Caragheorgheopol

Senior Resercher
Research Laboratory, C. I. Parhon National Institute of Endocrinology, Bucharest, Romania

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Corin Badiu

Professor
Carol Davila University of Medicine and Pharmacy, C.I. Parhon National Institute of Endocrinology
Bucuresti, Bucuresti, Romania

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