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PITUITARY STALK TRANSECTION SYNDROME : A LATE REVELATION

NR12. 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

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PITUITARY STALK TRANSECTION SYNDROME : A LATE REVELATION

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  1. NR12 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 SfarUniversity Hospital Center Mehdia, Tunisia *Department of InternalMedecine, Tahar SfarUniversity Hospital Center Mehdia, Tunisia

  2. INTRODUCTION • Growth 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

  3. 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

  4. Patients and Methods: • A 20 year old male • Growth retardation • Past history: • No foetal distress • No cranial trauma • Biological assessment, Anterior pituitary function exploration • Brain MRI were performed

  5. Results: • Biological assessment: No kind of misabsorption • Anterior pituitary function exploration: GH and Gonadotropin deficiency

  6. MRI: • Hypoplasia of the anterior hypophysis • Absence of pituitary stalk • Ectopic posterior hypophysis

  7. Gadolinium-enhanced coronal T1-weighted MR images : The pituitary stalk is not visibile (arrow)

  8. 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

  9. Unenhanced midline sagittal T1-weighted MR image shows the small anterior pituitary gland (short arrow) and ectopic posterior pituitary gland (long arrow)

  10. 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

  11. Magnetic resonance imaging (MRI) : • The diagnostic method of choice for idiopathic hypopituitarism • Excellent definition of the hypothalamic pituitary region • Gadolinium injection is necessary for a better description of the stalk

  12. 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

  13. 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 controls • Progression to complete anterior pituitary hormone deficiency may occur, even during the 2nd or the 3rd decade of life

  14. CONCLUSION: • Stalk transaction syndrome : • Relatively frequent • should be considered in patients who were previously thought to have idiopathic GH deficiency or pituitary hormone deficiency • MRI :the diagnostic method of choice showing pathognomonic characteristics • Require regular clinical survey and hormonal controls

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