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Surgical biopsies in patients with central diabetes insipidus and thickened pituitary stalks

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Abstract

Thickened pituitary stalks (TPSs) on magnetic resonance imaging (MRI) result from diverse pathologies; therefore, it is essential to make specific diagnoses for clinical decision-making. The diagnoses and indications for surgical biopsies in patients with central diabetes insipidus (CDI) and TPSs are thoroughly discussed in this paper. Thirty-seven patients with CDI and TPSs were retrospectively reviewed. The mean age at the diagnosis of CDI was 29.0 ± 15.9 years (range 8.0–63.3), and the median duration of follow-up was 5.5 ± 2.8 years (range 0.7–13.0). Anterior pituitary hormone deficiencies were documented in 26 (70.3 %) patients. All patients had a TPS on MRI at the diagnosis of CDI, and 21 (56.8 %) patients exhibited radiological changes during the follow-up. Of these 21 patients, 11 exhibited increases in the thickness of the stalk, and two patients exhibited reversals of the TPSs. Involvements of the hypothalamus, pituitary gland, basal ganglia or supersellar, and pineal gland were found in four, three, one, and 1 patient, respectively. Ultimately, clear diagnoses were established in 17 patients who underwent biopsies, nine of whom had germinomas, six of whom had Langerhans cell histiocytosis, one of whom had a granular cell tumor, and one of whom had Erdheim–Chester disease. Patients with CDI and TPSs should submit to periodic clinic follow-ups with serial MRI assessments to establish anterior pituitary deficiencies and to detect radiological progressions that are appropriate for surgical biopsies. Endoscopic-assisted microsurgery via the supraorbital keyhole approach is a good choice for the biopsy of pituitary stalk lesions.

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Abbreviations

CDI:

Central diabetes insipidus

TPS:

Thickened pituitary stalk

MRI:

Magnetic resonance imaging

ECD:

Erdheim-Chester disease

LCH:

Langerhans cell histiocytosis

ICA:

Internal carotid artery

CSF:

Cerebrospinal fluid

LH:

Lymphocytic hypophysitis

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Acknowledgments

We acknowledge the collaborative support of the endocrinologists, pathologists, radiologists, and physicians in our centre. This work was supported by grants to Qing-fang Sun from the National Natural Science Foundation of China (81270856) and Qin-yun Ma from the National Natural Science Foundation of China (81270867).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197, Ruijin Er Road, Shanghai, 200025, China

    Liuguan Bian, Xiao Chen, Yufan Chen & Qingfang Sun

  2. Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China

    Fangfang Jian, Shouyue Sun, Jun Yang, Qinyun Ma, Weiqing Wang & Guang Ning

  3. Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197, Ruijin Er Road, Shanghai, 200025, China

    Fei Miao

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  1. Fangfang Jian
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Correspondence to Guang Ning or Qingfang Sun.

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Jian, F., Bian, L., Sun, S. et al. Surgical biopsies in patients with central diabetes insipidus and thickened pituitary stalks. Endocrine 47, 325–335 (2014). https://doi.org/10.1007/s12020-014-0184-3

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