Panhypopituitarism - Magnetic resonance imaging findings in children and adults

Purpose: To review the magnetic resonance imaging (MRI) features of patients with panhypopituitarism to increase understanding of its etiology in children and adults. Methods: Of 75 patients diagnosed biochemically with panhypopituitarism, 62 underwent MRI of the sella and brain. These 62 patients were divided into two groups: children (younger than 16 years of age) and adults (older than 16 years of age). Imaging studies were retrospectively reviewed by consensus for presence, configuration, and signal characteristics of the anterior and posterior lobes of the pituitary gland, the hypothalamus, and the brain. Results: Forty-eight (77%) studies had abnormal findings; results of the remaining 14 (23%) were normal. In children (n = 25), sellar abnormalities were seen in 56% and included pituitary hypoplasia (n = 3), ectopic posterior lobe (n = 8), nonvisualization of the posterior lobe and stalk (n = 1), and sellar/parasellar masses (n = 2). Brain abnormalities observed in children with normal-appearing pituitary glands included septo-optic dysplasia (n = 5), holoprosencephaly (n = 3), cerebellar vermis anomalies (n = 1), and miscellaneous (n = 2). In adults (n = 23), sellar abnormalities were seen in 96% (n = 22) of the patients, and included micro- and macroadenoma (n = 8), empty sella (n = 2), Rathke's cleft cyst (n = 3), Sheehan syndrome (n = 3), and craniopharyngioma (n = 2). Miscellaneous sellar/parasellar abnormalities were identified in five patients. Overall, 12 (25%) patients with brain abnormalities and panhypopituitarism had normal-appearing pituitary glands. Conclusion: MRT identified abnormalities of the pituitary gland and brain in children and adults with pan-hypopituitarism. The etiology of panhypopituitarism differed in children and in adults. Of our patients, 54% had a normal-appearing pituitary gland; this group included 23% of patients with a normal-appearing brain.