Skip to main content
Log in

Diagnosis and Management of pituitary disease with focus on the role of Magnetic Resonance Imaging

  • Review
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Magnetic resonance (MR) imaging is an essential tool in the diagnosis and management of pituitary diseases, indispensable for making correct treatment decisions. Successful management and follow-up of pituitary pathology requires an understanding of the MR appearance of normal and abnormal structures in the sellar region. This review will describe the MR appearance of the normal and abnormal pituitary gland and proposes an algorithm for the management strategy of some of the most common abnormalities in or around the sella.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15

Similar content being viewed by others

References

  1. R.B. Dietrich, L.E. Lis, F.S. Greensite, D. Pitt, Normal MR appearance of the pituitary gland in the first 2 years of life. Am. J. Neuroradiol. 16, 1413–1419 (1995)

    CAS  PubMed  Google Scholar 

  2. B.S. Brooks, T. el Gammal, J.D. Allison, W.H. Hoffman, Frequency and variation of the posterior pituitary bright signal on MR images. Am. J. Neuroradiol. 10, 943–948 (1989)

    CAS  PubMed  Google Scholar 

  3. R.R. Lleva, S.E. Inzucchi, Diagnosis and management of pituitary adenomas. Curr. Opin. Oncol. 23, 53–60 (2011)

    PubMed  Google Scholar 

  4. M.E. Molitch, Diagnosis and treatment of pituitary adenomas: a review. Jama 317, 516–524 (2017)

    PubMed  Google Scholar 

  5. M.E. Molitch, Pituitary incidentalomas. Best. Pract. Res. Clin. Endocrinol. Metab. 23, 667–675 (2009)

    CAS  PubMed  Google Scholar 

  6. W.A. Hall, M.G. Luciano, J.L. Doppman, N.J. Patronas, E.H. Oldfield, Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population. Ann. Intern Med 120, 817–820 (1994)

    CAS  PubMed  Google Scholar 

  7. C.C. Chen, B.S. Carter, R. Wang, K.S. Patel, C. Hess, M.E. Bodach et al. Congress of neurological surgeons systematic review and evidence-based guideline on preoperative imaging assessment of patients with suspected nonfunctioning pituitary adenomas. Neurosurgery 79, E524–E526 (2016)

    PubMed  Google Scholar 

  8. A. Hagiwara, Y. Inoue, K. Wakasa, T. Haba, T. Tashiro, T. Miyamoto, Comparison of growth hormone-producing and non-growth hormone-producing pituitary adenomas: imaging characteristics and pathologic correlation. Radiology 228, 533–538 (2003)

    PubMed  Google Scholar 

  9. J. Gsponer, N. De Tribolet, J.P. Deruaz, R. Janzer, A. Uske, R.O. Mirimanoff et al. Diagnosis, treatment, and outcome of pituitary tumors and other abnormal intrasellar masses. Retrospective analysis of 353 patients. Med. (Baltim.) 78, 236–269 (1999)

    CAS  Google Scholar 

  10. M.M. Fernandez-Balsells, M.H. Murad, A. Barwise, J.F. Gallegos-Orozco, A. Paul, M.A. Lane et al. Natural history of nonfunctioning pituitary adenomas and incidentalomas: a systematic review and metaanalysis. J. Clin. Endocrinol. Metab. 96, 905–912 (2011)

    CAS  PubMed  Google Scholar 

  11. K. Arita, A. Tominaga, K. Sugiyama, K. Eguchi, K. Iida, M. Sumida et al. Natural course of incidentally found nonfunctioning pituitary adenoma, with special reference to pituitary apoplexy during follow-up examination. J. Neurosurg. 104, 884–891 (2006)

    PubMed  Google Scholar 

  12. O.M. Dekkers, S. Hammer, R.J. de Keizer, F. Roelfsema, P.J. Schutte, J.W. Smit et al. The natural course of non-functioning pituitary macroadenomas. Eur. J. Endocrinol. 156, 217–224 (2007)

    CAS  PubMed  Google Scholar 

  13. J.W. Lucas, M.E. Bodach, L.M. Tumialan, N.M. Oyesiku, C.G. Patil, Z. Litvack et al. Congress of neurological surgeons systematic review and evidence-based guideline on primary management of patients with nonfunctioning pituitary adenomas. Neurosurgery 79, E533–E535 (2016)

    PubMed  Google Scholar 

  14. P.J. Yeh, J.W. Chen, Pituitary tumors: surgical and medical management. Surg. Oncol. 6, 67–92 (1997)

    CAS  PubMed  Google Scholar 

  15. T. Mancini, F.F. Casanueva, A. Giustina, Hyperprolactinemia and prolactinomas. Endocrinol. Metab. Clin. North Am. 37, 67–99 (2008). viii

    CAS  PubMed  Google Scholar 

  16. F.F. Casanueva, M.E. Molitch, J.A. Schlechte, R. Abs, V. Bonert, M.D. Bronstein et al. Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas. Clin. Endocrinol. (Oxf.) 65, 265–273 (2006)

    Google Scholar 

  17. M.E. Molitch, Medical treatment of prolactinomas. Endocrinol. Metab. Clin. North Am. 28, 143–169 (1999). vii

    CAS  PubMed  Google Scholar 

  18. A. Klibanski, Clinical practice. Prolactinomas. N. Engl. J. Med 362, 1219–1226 (2010)

    CAS  PubMed  Google Scholar 

  19. M. Buchfelder, S. Schlaffer, Imaging of pituitary pathology. Handb. Clin. Neurol. 124, 151–166 (2014)

    PubMed  Google Scholar 

  20. J.F. Bonneville, F. Bonneville, F. Cattin, Magnetic resonance imaging of pituitary adenomas. Eur. Radio. 15, 543–548 (2005)

    Google Scholar 

  21. L. Katznelson, E.R. Laws Jr, S. Melmed, M.E. Molitch, M.H. Murad, A. Utz et al. Acromegaly: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 99, 3933–3951 (2014)

    CAS  PubMed  Google Scholar 

  22. A. Mestron, S.M. Webb, R. Astorga, P. Benito, M. Catala, S. Gaztambide et al. Epidemiology, clinical characteristics, outcome, morbidity and mortality in acromegaly based on the Spanish Acromegaly Registry (Registro Espanol de Acromegalia, REA). Eur. J. Endocrinol. 151, 439–446 (2004)

    CAS  PubMed  Google Scholar 

  23. J.L. Shin, S.L. Asa, L.J. Woodhouse, H.S. Smyth, S. Ezzat, Cystic lesions of the pituitary: clinicopathological features distinguishing craniopharyngioma, Rathke’s cleft cyst, and arachnoid cyst. J. Clin. Endocrinol. Metab. 84, 3972–3982 (1999)

    CAS  PubMed  Google Scholar 

  24. A. Teramoto, K. Hirakawa, N. Sanno, Y. Osamura, Incidental pituitary lesions in 1,000 unselected autopsy specimens. Radiology 193, 161–164 (1994)

    CAS  PubMed  Google Scholar 

  25. S.Q. Wolfe, R.C. Heros, Editorial. J. Neurosurg. 112, 1322–1323 (2010)

    PubMed  Google Scholar 

  26. C.J. Aho, C. Liu, V. Zelman, W.T. Couldwell, M.H. Weiss, Surgical outcomes in 118 patients with Rathke cleft cysts. J. Neurosurg. 102, 189–193 (2005)

    PubMed  Google Scholar 

  27. L. Cervoni, M. Artico, M. Salvati, S. Carloia, Rathke’s cleft cyst: a clinical and radiographic review. Ital. J. Neurol. Sci. 18, 37–40 (1997)

    CAS  PubMed  Google Scholar 

  28. S. Chotai, Y. Liu, J. Pan, S. Qi, Characteristics of Rathke’s cleft cyst based on cyst location with a primary focus on recurrence after resection. J. Neurosurg. 122, 1380–1389 (2015)

    PubMed  Google Scholar 

  29. S.M. Tavangar, B. Larijani, A. Mahta, S.M. Hosseini, M. Mehrazine, F. Bandarian, Craniopharyngioma: a clinicopathological study of 141 cases. Endocr. Pathol. 15, 339–344 (2004). Winter

    PubMed  Google Scholar 

  30. T.B. Crotty, B.W. Scheithauer, W.F. Young Jr, D.H. Davis, E.G. Shaw, G.M. Miller et al. Papillary craniopharyngioma: a clinicopathological study of 48 cases. J. Neurosurg. 83, 206–214 (1995)

    CAS  PubMed  Google Scholar 

  31. N. Karavitaki, C. Brufani, J.T. Warner, C.B. Adams, P. Richards, O. Ansorge et al. Craniopharyngiomas in children and adults: systematic analysis of 121 cases with long-term follow-up. Clin. Endocrinol. (Oxf.) 62, 397–409 (2005)

    CAS  Google Scholar 

  32. R. Sorva, O. Heiskanen, Craniopharyngioma in Finland. Acta Neurochirurgica 81, 85–89 (1986)

    CAS  PubMed  Google Scholar 

  33. M. Güdük, M. HamitAytar, A. Sav, Z. Berkman, Intrasellar arachnoid cyst: a case report and review of the literature. Int. J. Surg. case Rep. 23, 105–108 (2016)

    PubMed  PubMed Central  Google Scholar 

  34. F. Gudinchet, F. Brunelle, M.O. Barth, V. Taviere, R. Brauner, R. Rappaport et al. MR imaging of the posterior hypophysis in children. AJR Am. J. Roentgenol. 153, 351–354 (1989)

    CAS  PubMed  Google Scholar 

  35. A.F. Turcu, B.J. Erickson, E. Lin, S. Guadalix, K. Schwartz, B.W. Scheithauer et al. Pituitary stalk lesions: the Mayo Clinic experience. J. Clin. Endocrinol. Metab. 98, 1812–1818 (2013)

    CAS  PubMed  Google Scholar 

  36. B.E. Hamilton, K.L. Salzman, A.G. Osborn, Anatomic and pathologic spectrum of pituitary infundibulum lesions. AJR Am. J. Roentgenol. 188, W223–W232 (2007)

    PubMed  Google Scholar 

  37. M.E. Molitch, M.P. Gillam, Lymphocytic hypophysitis. Horm. Res 68, 145–150 (2007)

    PubMed  Google Scholar 

  38. P. Caturegli, C. Newschaffer, A. Olivi, M.G. Pomper, P.C. Burger, N.R. Rose, Autoimmune hypophysitis. Endocr. Rev. 26, 599–614 (2005)

    CAS  PubMed  Google Scholar 

  39. H. Bando, G. Iguchi, H. Fukuoka, M. Taniguchi, M. Yamamoto, R. Matsumoto et al. The prevalence of IgG4-related hypophysitis in 170 consecutive patients with hypopituitarism and/or central diabetes insipidus and review of the literature. Eur. J. Endocrinol. 170, 161–172 (2014)

    CAS  PubMed  Google Scholar 

  40. J. Shikuma, K. Kan, R. Ito, K. Hara, H. Sakai, T. Miwa et al. Critical review of IgG4-related hypophysitis. Pituitary 20, 282–291 (2017)

    CAS  PubMed  Google Scholar 

  41. M.N. Joshi, B.C. Whitelaw, M.T. Palomar, Y. Wu, P.V. Carroll, Immune checkpoint inhibitor-related hypophysitis and endocrine dysfunction: clinical review. Clin. Endocrinol. (Oxf.) 85, 331–339 (2016)

    CAS  Google Scholar 

  42. Y. Okano, T. Satoh, K. Horiguchi, M. Toyoda, A. Osaki, S. Matsumoto et al. Nivolumab-induced hypophysitis in a patient with advanced malignant melanoma. Endocr. J. 63, 905–912 (2016)

    PubMed  Google Scholar 

  43. C. Briet, S. Salenave, J.-F. Bonneville, E.R. Laws, P. Chanson, Pituitary apoplexy. Endocr. Rev. 36, 622–645 (2015)

    PubMed  Google Scholar 

  44. A. Raappana, J. Koivukangas, T. Ebeling, T. Pirila, Incidence of pituitary adenomas in Northern Finland in 1992–2007. J. Clin. Endocrinol. Metab. 95, 4268–4275 (2010)

    CAS  PubMed  Google Scholar 

  45. N. Kurihara, S. Takahashi, S. Higano, H. Ikeda, S. Mugikura, L.N. Singh et al. Hemorrhage in pituitary adenoma: correlation of MR imaging with operative findings. Eur. Radiol. 8, 971–976 (1998)

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Amit Mahajan.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mahajan, A., Bronen, R.A., Mian, A.Y. et al. Diagnosis and Management of pituitary disease with focus on the role of Magnetic Resonance Imaging. Endocrine 68, 489–501 (2020). https://doi.org/10.1007/s12020-020-02242-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-020-02242-3

Keywords

Navigation