Mirjana Doknic1,2, Dragana Miljic3,4, Sandra Pekic3,4, Marko Stojanovic3,4, Dragan Savic5,4, Emilija Manojlovic-Gacic6,4, Tatjana Milenkovic7, Vera Zdravkovic8,4, Maja Jesic8,4, Dusan Damjanovic9,4, Slobodan Lavrnic9, Ivan Soldatovic10,4, Aleksandar Djukic11, Milan Petakov3,4. 1. Neuroendocrine Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotica 13, Belgrade, 11000, Serbia. mirjanadoknic@gmail.com. 2. School of Medicine, University of Belgrade, Belgrade, Serbia. mirjanadoknic@gmail.com. 3. Neuroendocrine Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotica 13, Belgrade, 11000, Serbia. 4. School of Medicine, University of Belgrade, Belgrade, Serbia. 5. Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia. 6. Institute of Pathology, School of Medicine, University of Belgrade, Belgrade, Serbia. 7. Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Belgrade, Serbia. 8. University Children's Clinic, Belgrade, Serbia. 9. Center for Radiology Imaging - Magnetic Resonance and Gamma Knife, Clinical Center of Serbia, Belgrade, Serbia. 10. Institute of Medical Statistics and Informatics, Belgrade, Serbia. 11. Center for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Kragujevac, Kragujevac, Serbia.
Abstract
BACKGROUND: The etiological spectrum of pituitary stalk lesions (PSL) is wide and yet specific compared to the other diseases of the sellar and suprasellar region. Because of the pituitary stalk's (PS) critical location and role, biopsies of these lesions are rarely performed, and their underlying pathology is often a conundrum for clinicians. A pituitary MRI in association with a clinical context can facilitate their diagnosis. AIM: To present the various causes of PSL-their clinical, hormonal, histopathological, and MRI characteristics in order to gain better insight into this pathology. METHOD: A retrospective observational study consisting of 53 consecutive patients with PSL of the mean age 32 ± 4.2 years (range 6-67), conducted at the Department for Neuroendocrinology, Clinical Center of Serbia 2010-2018. RESULTS: Congenital malformations were the most common cause of PSL in 25 of 53 patients (47.1%), followed by inflammatory (9/53; 16.9%) and neoplastic lesions (9/53; 16.9%). The exact cause of PSL was established in 31 (58.4%) patients, of whom 23 were with congenital PS abnormalities and 8 with histopathology of PSL (7 neoplastic and 1 Langerhans Cell Hystiocytosis). A probable diagnosis of PSL was stated in 12 patients (22.6%): 6 with lymphocytic panhypophysitis, while Rathke cleft cyst, tuberculosis, dissemination of malignancy in PS were each diagnosed in 2 patients. In 10 patients (18.8%), the etiology of PSL remained unknown. CONCLUSION: Due to the inability of establishing an exact diagnosis, the management and prognosis of PSL are difficult in many patients. By presenting a wide array of causes implicated in this condition, we believe that our study can aid clinicians in the challenging cases of this pathology.
BACKGROUND: The etiological spectrum of pituitary stalk lesions (PSL) is wide and yet specific compared to the other diseases of the sellar and suprasellar region. Because of the pituitary stalk's (PS) critical location and role, biopsies of these lesions are rarely performed, and their underlying pathology is often a conundrum for clinicians. A pituitary MRI in association with a clinical context can facilitate their diagnosis. AIM: To present the various causes of PSL-their clinical, hormonal, histopathological, and MRI characteristics in order to gain better insight into this pathology. METHOD: A retrospective observational study consisting of 53 consecutive patients with PSL of the mean age 32 ± 4.2 years (range 6-67), conducted at the Department for Neuroendocrinology, Clinical Center of Serbia 2010-2018. RESULTS:Congenital malformations were the most common cause of PSL in 25 of 53 patients (47.1%), followed by inflammatory (9/53; 16.9%) and neoplastic lesions (9/53; 16.9%). The exact cause of PSL was established in 31 (58.4%) patients, of whom 23 were with congenital PS abnormalities and 8 with histopathology of PSL (7 neoplastic and 1 Langerhans Cell Hystiocytosis). A probable diagnosis of PSL was stated in 12 patients (22.6%): 6 with lymphocytic panhypophysitis, while Rathke cleft cyst, tuberculosis, dissemination of malignancy in PS were each diagnosed in 2 patients. In 10 patients (18.8%), the etiology of PSL remained unknown. CONCLUSION: Due to the inability of establishing an exact diagnosis, the management and prognosis of PSL are difficult in many patients. By presenting a wide array of causes implicated in this condition, we believe that our study can aid clinicians in the challenging cases of this pathology.
Authors: Eva Fernandez-Rodriguez; Celsa Quinteiro; Jesus Barreiro; Mónica Marazuela; Inmaculada Pereiro; Roberto Peinó; Jose Manuel Cabezas-Agrícola; Fernando Dominguez; Felipe F Casanueva; Ignacio Bernabeu Journal: Neuroendocrinology Date: 2011-02-08 Impact factor: 4.914
Authors: F J Salge-Arrieta; R Carrasco-Moro; V Rodríguez-Berrocal; H Pian; J S Martínez-San Millán; P Iglesias; L Ley-Urzáiz Journal: J Endocrinol Invest Date: 2018-07-20 Impact factor: 4.256
Authors: K A Lieberman; J J Wasenko; R Schelper; A Swarnkar; J K Chang; G S Rodziewicz Journal: AJNR Am J Neuroradiol Date: 2003 Nov-Dec Impact factor: 3.825