RESUMEN
PURPOSE: The histopathological study of brain tissue is a common method in neuroscience. However, efficient procedures to preserve the intact hypothalamic-pituitary brain specimens are not available in mice for histopathological study. METHOD: We describe a detailed procedure for obtaining mouse brain with pituitary-hypothalamus continuity. Unlike the traditional methods, we collect the brain via a ventral approach. We cut the intraoccipital synchondrosis, transection the endocranium of pituitary, broke the spheno-occipital synchondrosis, expose the posterior edge of pituitary, separate the trigeminal nerve, then the intact pituitary gland was preserved. RESULT: We report an more effective and practical method to obtain continuous hypothalamus -pituitary preparations based on the preserve of leptomeninges. COMPARED WITH THE EXISTING METHODS: Our procedure effectively protects the integrity of the fragile infundibulum preventing the pituitary from separating from the hypothalamus. This procedure is more convenient and efficient. CONCLUSION: We present a convenient and practical procedure to obtain intact hypothalamic-pituitary brain specimens for subsequent histopathological evaluation in mice.
Asunto(s)
Enfermedades de la Hipófisis , Neurohipófisis , Ratones , Animales , Hipófisis/patología , Neurohipófisis/patología , Hipotálamo/patología , Sistema Hipotálamo-Hipofisario , Enfermedades de la Hipófisis/cirugía , Enfermedades de la Hipófisis/patologíaRESUMEN
CONTEXT: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a severe chronic illness that reduces the quality of life. A potential role of neuroendocrine autoimmune dysfunction has been hypothesized. OBJECTIVE: This work aims to investigate the occurrence of antipituitary (APA) and antihypothalamic (AHA) antibodies and possible related hypothalamic/pituitary dysfunctions in ME/CSF patients. METHODS: This is a case-control study conducted in a university hospital setting (Stanford, California, USA; and Naples, Italy). Thirty women with ME/CSF (group 1) diagnosed according to Fukuda, Canadian, and Institute of Medicine criteria, at Stanford University, were enrolled and compared with 25 age-matched healthy controls. APA and AHA were detected by immunofluorescence; moreover, we investigated hormonal secretions of anterior pituitary and respective target glands. APA and AHA titers both were assessed and the prevalence of pituitary hormone deficiencies was also investigated. RESULTS: Patients in group 1 showed a high prevalence of AHA (33%) and APA (56%) and significantly lower levels of adrenocorticotropin (ACTH)/cortisol, and growth hormone (GH) peak/insulin-like growth factor-1 (IGF-1) vs controls (all AHA/APA negative). Patients in group 1A (13 patients positive at high titers, ≥â 1:32) showed ACTH/cortisol and GH peak/IGF-1 levels significantly lower and more severe forms of ME/CFS with respect to patients in group 1B (7 positive at middle/low titers, 1:16-1:8) and 1C (10 antibody-negative patients). CONCLUSION: Both AHA and/or APA at high titers were associated with hypothalamic/pituitary dysfunction, suggesting that hypothalamic/pituitary autoimmunity may play an important role in the manifestations of ME/CFS, especially in its more severe forms.
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Autoanticuerpos/sangre , Enfermedades Autoinmunes/epidemiología , Biomarcadores/sangre , Síndrome de Fatiga Crónica/fisiopatología , Hipotálamo/patología , Enfermedades de la Hipófisis/epidemiología , Hormona Adrenocorticotrópica/sangre , Adulto , Autoanticuerpos/inmunología , Enfermedades Autoinmunes/sangre , Enfermedades Autoinmunes/inmunología , Enfermedades Autoinmunes/patología , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Hormona de Crecimiento Humana/sangre , Humanos , Hipotálamo/inmunología , Hipotálamo/metabolismo , Factor I del Crecimiento Similar a la Insulina/análisis , Enfermedades de la Hipófisis/sangre , Enfermedades de la Hipófisis/inmunología , Enfermedades de la Hipófisis/patología , Pronóstico , Estados Unidos/epidemiología , Adulto JovenRESUMEN
BACKGROUND: To determine the impact of hypothalamic-pituitary (HP) disorders on health outcomes in children and adolescents who received conformal radiation therapy (RT) for central nervous system tumors. PROCEDURE: Cohort study including 355 patients (age ≤25 years at diagnosis) treated with high-dose (50.4-59.4 Gy) RT using photons for low-grade glioma or ependymoma. Patients (median age, 6.4 years at RT) received systematic endocrine follow-up (median duration, 10.1 years; range, 0.1-19.6). Associations between HP disorders and adverse health outcomes were determined by multivariable analysis. RESULTS: Prevalence was 37.2% for growth hormone deficiency (GHD), 17.7% for gonadotropin deficiency (LH/FSHD), 14.9% for thyroid-stimulating hormone deficiency (TSHD), 10.3% for adrenocorticotropic hormone deficiency (ACTHD), and 12.6% for central precocious puberty (CPP). Hypothalamus mean dose ≥ 36 Gy was associated with higher odds of any deficiency. GHD was associated with short stature (OR 2.77; 95% CI 1.34-5.70), low bone mineral density (OR 3.47; 95% CI 1.16-10.40), and TSHD with dyslipidemia (OR 5.54; 95% CI 1.66-18.52). Patients with ACTHD and CPP had lower intelligence quotient scores, and memory scores were impaired in patients with GHD (P = 0.02). Treatment of GHD was not associated with increased risk for tumor recurrence, secondary tumors, or mortality. CONCLUSIONS: HP disorders occur frequently in patients receiving high-dose RT and are related to physical and neurocognitive well-being. Future studies are needed to assess whether further optimization of endocrine management yields better health outcomes.
Asunto(s)
Ependimoma/radioterapia , Glioma/radioterapia , Trastornos del Crecimiento/patología , Hormona de Crecimiento Humana/uso terapéutico , Enfermedades Hipotalámicas/patología , Enfermedades de la Hipófisis/patología , Radioterapia Conformacional/efectos adversos , Adolescente , Adulto , Niño , Preescolar , Ependimoma/patología , Femenino , Estudios de Seguimiento , Glioma/patología , Trastornos del Crecimiento/tratamiento farmacológico , Trastornos del Crecimiento/etiología , Humanos , Enfermedades Hipotalámicas/tratamiento farmacológico , Enfermedades Hipotalámicas/etiología , Lactante , Masculino , Enfermedades de la Hipófisis/tratamiento farmacológico , Enfermedades de la Hipófisis/etiología , Pronóstico , Estudios Retrospectivos , Adulto JovenRESUMEN
A heterogeneous group of epithelial cystic tumors developed at the infundibulum and the third ventricle disconcerted pathologists at the dawn of the twentieth century. Very little was known at that time about the physiological role played by the pituitary gland, and there was almost complete ignorance regarding the function of the hypothalamus. Acromegaly, or enlargement of acral body parts, described in 1886 by Pierre Marie, was the only disease linked to primary hypertrophies of the pituitary gland, known as "pituitary strumas". A growing number of young patients manifesting an unexplained combination of physical and mental symptoms, including absent or delayed sexual maturation, progressive obesity, abnormal somnolence, and dementia-like changes in behavior were reported to present large solid-cystic tumors which characteristically expanded within the infundibulum and third ventricle, above an anatomically intact pituitary gland. Between 1899 and 1904, five seminal autopsy studies from different countries thoroughly described the anatomical relationships and histological features of this newly recognized type of infundibular tumors. These cases were instrumental in fostering the systematic investigation of similar lesions by the Austrian pathologist Jakob Erdheim (1874-1937), who in 1904 was able to classify these infundibulo-tuberal cysts under the common category of hypophyseal duct tumors. The pioneering American neurosurgeon Harvey Cushing (1869-1939) unsuccessfully attempted to surgically remove one of these cysts, for the first time in history, in 1902. The term "craniopharyngioma", chosen by Cushing in 1929 to designate these lesions, would eventually prevail over Erdheim's more accurate denomination, which linked their origin to squamous cell remnants derived from the embryological structures that give rise to the pituitary gland. This paper presents a comprehensive, renewed account of the five clinical-pathological reports which laid the groundwork for the proper clinical diagnosis, topographic conceptualization and pathological categorization of craniopharyngiomas.
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Autopsia/métodos , Craneofaringioma/diagnóstico , Craneofaringioma/patología , Adolescente , Adulto , Femenino , Humanos , Hipotálamo/patología , Masculino , Enfermedades de la Hipófisis/diagnóstico , Enfermedades de la Hipófisis/patología , Hipófisis/diagnóstico por imagen , Hipófisis/patología , Adulto JovenRESUMEN
This review summarized different studies reporting the presence of autoantibodies reacting against cells of the pituitary (APAs) and/or hypothalamus (AHAs). Both APAs and AHAs have been revealed through immunofluorescence using different kinds of substrates. Autoantibodies against gonadotropic cells were mainly found in patients affected by cryptorchidism and hypogonadotropic hypogonadism while those against prolactin cells were found in different kinds of patients, the majority without pituitary abnormalities. APAs to growth hormone (GH) cells have been associated with GH deficiency while those against the adrenocorticotropic cells have distinguished central Cushing's disease patients at risk of incomplete cure after surgical adenoma removal. AHAs to vasopressin cells have identified patients at risk of developing diabetes insipidus. APAs have been also found together with AHAs in patients affected by idiopathic hypopituitarism, but both were also present in different kinds of patients without abnormalities of the hypothalamic-pituitary axis. Despite some data being promising, the clinical use of pituitary and hypothalamus autoantibodies is still limited by the low diagnostic sensitivity, irreproducibility of the results, and the absence of autoantigen/s able to discriminate the autoimmune reaction involving the pituitary or the hypothalamus from the other autoimmune states.
Asunto(s)
Autoanticuerpos/inmunología , Enfermedades Autoinmunes/inmunología , Autoinmunidad , Enfermedades Hipotalámicas/inmunología , Hipotálamo/inmunología , Enfermedades de la Hipófisis/inmunología , Hipófisis/inmunología , Animales , Autoanticuerpos/análisis , Enfermedades Autoinmunes/patología , Hormona del Crecimiento/inmunología , Humanos , Hipopituitarismo/inmunología , Hipopituitarismo/patología , Enfermedades Hipotalámicas/patología , Hipotálamo/patología , Enfermedades de la Hipófisis/patología , Hipófisis/patologíaRESUMEN
PURPOSE: Infundibulo-tuberal syndrome groups endocrine, metabolic and behavioral disturbances caused by lesions involving the upper neurohypophysis (median eminence) and adjacent basal hypothalamus (tuber cinereum). It was originally described by Henri Claude and Jean Lhermitte in 1917, in a patient with a craniopharyngioma. This study investigates the clinical, pathological and surgical evidence verifying the infundibulo-tuberal syndrome caused by craniopharyngiomas (CPs). METHODS: A systematic retrospective review of craniopharyngiomas reported in French literature between 1705 and 1973 was conducted. A total of 128 well described reports providing a comprehensive clinical and pathological description of the tumors were selected. This series represents the historical French cohort of CPs reported in the pre-CT/MRI era. RESULTS: Three major syndromes caused by CPs were categorized: pituitary syndrome (35%), infundibulo-tuberal syndrome (52%) and hypothalamic syndrome (49%). CP topography was significantly related to the type of syndrome described (p < 0.001). Infundibulo-tuberal syndrome occurred in CPs which replaced or invaded the third ventricle floor. In contrast, the majority of sellar/suprasellar CPs growing below the third ventricle showed a pituitary syndrome (82%). Cases with hypothalamic syndrome were characterized by anatomical integrity of the pituitary gland and stalk (p = 0.033) and occurred predominantly in adults older than 41 years old (p < 0.005). Among infundibulo-tuberal symptoms, abnormal somnolence was not related with the presence of hydrocephalus. All squamous-papillary CPs presented psychiatric disturbances (p < 0.001). CONCLUSION: This historical CP cohort evidences a clinical-topographical correlation between the patient's type of syndrome and the anatomical structures involved by the tumor along the hypophysial-hypothalamic axis.
Asunto(s)
Ventrículos Cerebrales/patología , Craneofaringioma/complicaciones , Enfermedades Hipotalámicas/etiología , Hipotálamo/patología , Enfermedades de la Hipófisis/etiología , Hipófisis/patología , Neoplasias Hipofisarias/complicaciones , Adolescente , Adulto , Anciano , Ventrículos Cerebrales/fisiopatología , Niño , Preescolar , Craneofaringioma/patología , Craneofaringioma/fisiopatología , Femenino , Francia , Humanos , Enfermedades Hipotalámicas/patología , Enfermedades Hipotalámicas/fisiopatología , Hipotálamo/fisiopatología , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Enfermedades de la Hipófisis/patología , Enfermedades de la Hipófisis/fisiopatología , Hipófisis/fisiopatología , Neoplasias Hipofisarias/patología , Neoplasias Hipofisarias/fisiopatología , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Síndrome , Adulto JovenRESUMEN
To report an unusual case of biopsy-proven autoimmune hypophysitis with predominant hypothalamic involvement associated with empty sella, panhypopituitarism, visual disturbances and antipituitary antibodies positivity. We present the history, physical findings, hormonal assay results, imaging, surgical findings and pathology at presentation, together with a 2-year follow-up. A literature review on the hypothalamic involvement of autoimmune hypophysitis with empty sella was performed. A 48-year-old woman presented with polyuria, polydipsia, asthenia, diarrhea and vomiting. The magnetic resonance imaging (MRI) revealed a clear suprasellar (hypothalamic) mass, while the pituitary gland appeared atrophic. Hormonal testing showed panhypopituitarism and hyperprolactinemia; visual field examination was normal. Pituitary serum antibodies were positive. Two months later an MRI documented a mild increase of the lesion. The patient underwent biopsy of the lesion via a transsphenoidal approach. Histological diagnosis was lymphocytic "hypothalamitis". Despite 6 months of corticosteroid therapy, the patient developed bitemporal hemianopia and blurred vision, without radiological evidence of chiasm compression, suggesting autoimmune optic neuritis with uveitis. Immunosuppressive treatment with azathioprine was then instituted. Two months later, an MRI documented a striking reduction of the hypothalamic lesion and visual field examination showed a significant improvement. The lesion is stable at the 2-year follow-up. For the first time we demonstrated that "hypothalamitis" might be the possible evolution of an autoimmune hypophysitis, resulting in pituitary atrophy, secondary empty sella and panhypopituitarism. Although steroid treatment is advisable as a first line therapy, immunosuppressive therapy with azathioprine might be necessary to achieve disease control.
Asunto(s)
Enfermedades Hipotalámicas/diagnóstico , Enfermedades Hipotalámicas/terapia , Corticoesteroides/uso terapéutico , Enfermedades Autoinmunes/complicaciones , Enfermedades Autoinmunes/tratamiento farmacológico , Azatioprina/uso terapéutico , Femenino , Hormonas/sangre , Humanos , Enfermedades Hipotalámicas/tratamiento farmacológico , Hipotálamo/patología , Inmunosupresores/uso terapéutico , Persona de Mediana Edad , Enfermedades de la Hipófisis/patología , Pruebas de Función HipofisariaRESUMEN
OBJECTIVE: Langerhans cell histiocytosis (LCH) is a rare idiopathic disease that is characterized by clonal proliferation of Langerhans histiocytes in various parts of the body. These atypical cells have been found to infiltrate single or multiple organs, including bone, lungs, liver, spleen, lymph nodes, and skin. Central nervous system invasion in LCH patients has rarely been reported, especially in the adult population. METHODS AND RESULTS: We describe three histopathologically confirmed cases of adult LCH that involves both the pituitary stalk and hypothalamus, and report our limited experience of such cases in this location that has been treated with CyberKnife radio surgery. CONCLUSION: The treatment goal of controlling lesion growth is achieved by CyberKnife radiosurgery in this case series. All patients tolerated the treatment well without obvious complications.
Asunto(s)
Histiocitosis de Células de Langerhans/cirugía , Enfermedades de la Hipófisis/cirugía , Hipófisis/cirugía , Radiocirugia/métodos , Adulto , Biopsia , Encéfalo/patología , Diabetes Insípida/complicaciones , Diabetes Gestacional/patología , Femenino , Histiocitosis de Células de Langerhans/patología , Terapia de Reemplazo de Hormonas , Humanos , Hipotálamo/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Quiasma Óptico/patología , Enfermedades de la Hipófisis/patología , Hipófisis/patología , Hormonas Hipofisarias/uso terapéutico , Poliuria/etiología , Embarazo , Sed , Campos Visuales/fisiologíaRESUMEN
PURPOSE: Chronic pituitary dysfunction is increasingly recognized as a sequela of traumatic brain injury (TBI). Our aim was to rule out any late morphometric changes of the pituitary gland and hypothalamus in survivors of TBI during childhood requiring intensive care. METHODS: We assessed morphometric abnormalities of the sella region and hypothalamus in patients who sustained TBI during childhood. The patients showed no clinical hormonal dysfunction at the acute phase and pituitary hormone levels at the time of our study were within normal limits. From the 18 enrolled patients in the magnetic resonance study, five were removed due to morphological changes or anatomical variations. We studied the MRI of 13 male survivors (mean age 27 years, mean time after trauma 20 years) and compared them to 13 male control subjects who were matched in terms of age (mean age, 26 years), education and ethnicity. Analyses of the pituitary gland and sella on a midsagittal T2- and T1-weighted image were performed. We used voxel-based morphometry (VBM), an unbiased MRI morphometric method to investigate hypothalamic region in this group of patients. RESULTS: There was only a trend towards a reduced pituitary gland width in the patient group compared to controls. However, no significant morphological and morphometric abnormality was seen and VBM showed no hypothalamic grey matter loss. CONCLUSION: In the absence of hormonal dysfunction, no persisting morphometric changes of the pituitary gland and hypothalamus were seen in survivors of childhood TBI requiring intensive care.
Asunto(s)
Lesiones Encefálicas/complicaciones , Hipotálamo/patología , Hipófisis/patología , Sobrevivientes , Adulto , Niño , Humanos , Enfermedades Hipotalámicas/epidemiología , Enfermedades Hipotalámicas/etiología , Enfermedades Hipotalámicas/patología , Interpretación de Imagen Asistida por Computador , Imagen por Resonancia Magnética , Masculino , Enfermedades de la Hipófisis/epidemiología , Enfermedades de la Hipófisis/etiología , Enfermedades de la Hipófisis/patologíaRESUMEN
Pubertal development is impaired in mice lacking the basic helix-loop-helix transcription factor Nhlh2. The mechanisms underlying changes in reproduction in Nhlh2-deficient mice (Nhlh2(-/-)) are unclear. Here we show that hypothalamic GnRH-1 content is reduced in adult Nhlh2(-/-) mice as is the number of GnRH-1 neurons localized to mid- and caudal hypothalamic regions. This reduction was detected postnatally after normal migration of GnRH-1 neurons within nasal regions had occurred. Phenotype rescue experiments showed that female Nhlh2(-/-) mice were responsive to estrogen treatment. In contrast, puberty could not be primed in female Nhlh2(-/-) mice with a GnRH-1 regimen. The adenohypophysis of Nhlh2(-/-) mice was hypoplastic although it contained a full complement of the five anterior pituitary cell types. GnRH-1 receptors (GnRHRs) were reduced in Nhlh2(-/-) pituitary gonadotropes as compared with wild type. In vitro assays indicated that Nhlh2 expression is regulated in parallel with GnRHR expression. However, direct transcriptional activity of Nhlh2 on the GnRHR promoter was not found. These results indicate that Nhlh2 plays a role in the development and functional maintenance of the hypothalamic-pituitary-gonadal axis at least at two levels: 1) in the hypothalamus by regulating the number and distribution of GnRH-1 neurons and, 2) in the developing and mature adenohypophysis.
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Envejecimiento/fisiología , Factores de Transcripción con Motivo Hélice-Asa-Hélice Básico/deficiencia , Factores de Transcripción con Motivo Hélice-Asa-Hélice Básico/metabolismo , Hipotálamo/fisiopatología , Enfermedades de la Hipófisis/fisiopatología , Maduración Sexual , Animales , Animales Recién Nacidos , Factores de Transcripción con Motivo Hélice-Asa-Hélice Básico/genética , Movimiento Celular , Células Cultivadas , Femenino , Regulación de la Expresión Génica , Hormona Liberadora de Gonadotropina/metabolismo , Hipotálamo/patología , Ratones , Ratones Noqueados , Neuronas/citología , Neuronas/metabolismo , Fenotipo , Enfermedades de la Hipófisis/genética , Enfermedades de la Hipófisis/patologíaRESUMEN
In the report a patient who suffered from secondary amenorrhea for 6 years and primary infertility for 2 years due to pituitary atrophy was successfully cured with Chinese herbs. After orally administered Chinese herbs for 1 month, the patient menstruated once and became pregnant later.
Asunto(s)
Medicamentos Herbarios Chinos/uso terapéutico , Fitoterapia , Enfermedades de la Hipófisis/diagnóstico , Enfermedades de la Hipófisis/tratamiento farmacológico , Adulto , Amenorrea/diagnóstico , Amenorrea/tratamiento farmacológico , Amenorrea/patología , Diagnóstico Diferencial , Femenino , Humanos , Infertilidad Femenina/diagnóstico , Infertilidad Femenina/tratamiento farmacológico , Infertilidad Femenina/patología , Imagen por Resonancia Magnética , Enfermedades de la Hipófisis/patología , EmbarazoRESUMEN
BACKGROUND: Lymphocytic adenohypohysitis and lymphocytic infundibulo-neurohypophysitis are rare auto-immune mediated diseases of the anterior and posterior pituitary, respectively. The former usually manifests as insufficiency of anterior pituitary hormone secretion, associated in many patients with disturbances of vision. The latter presents as diabetes insipidus of central origin. They present most commonly in pregnant or postpartum females. There have been infrequent reports in females with no association with pregnancy, and in males. CASE DESCRIPTION: We present a nulliparous female with central diabetes insipidus, pan-hypopituitarism, and severely impaired vision. Magnetic resonance imaging demonstrated a large mass involving the hypothalamus, infundibulum, optic nerves, chiasm, and tracts. At operation, the optic pathways were found to be grossly involved in the inflammatory mass. Histological examination of a biopsy demonstrated a nonspecific, mixed inflammatory infiltrate, composed predominantly of lymphocytes and plasma cells. She responded dramatically to treatment with dexamethasone, with disappearance of the mass on serial imaging studies and improvement in vision. In addition, she received hormone replacement therapy. CONCLUSION: We present a case of lymphocytic infundibulo-neurohypophysitis unique in the degree of optic pathway inflammatory involvement, with a documented response to steroids.
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Núcleo Arqueado del Hipotálamo/patología , Hipotálamo/patología , Linfocitos/inmunología , Linfocitos/patología , Enfermedades de la Hipófisis/inmunología , Enfermedades de la Hipófisis/patología , Vías Visuales/patología , Hormona Adrenocorticotrópica/sangre , Adulto , Biopsia , Femenino , Hormona Folículo Estimulante/sangre , Hormona de Crecimiento Humana/sangre , Humanos , Hormona Luteinizante/sangre , Imagen por Resonancia Magnética , Prolactina/sangre , Valores de Referencia , Tirotropina/sangreRESUMEN
Langerhans cell histiocytosis rarely presents as a solitary lesion in the pituitary-hypothalamic region, and is indistinguishable from germinoma, which occurs much more frequently, especially in Japanese. A 14-year-old girl and a 9-year-old girl presented with polydipsia and polyuria as the initial symptoms. Magnetic resonance (MR) imaging demonstrated a round mass at the pituitary stalk appearing as isointense on T1-weighted imaging and hyperintense on T2-weighted imaging. Endocrinological examination revealed mild hypopituitarism with central diabetes insipidus. Both patients underwent open craniotomy. Histological examination revealed granulomatous tissue with eosinophil infiltration and frequent Langerhans histiocyte clustering, compatible with the diagnosis of Langerhans cell histiocytosis. Low-dose local irradiation of 20 Gy was administered. First patient was followed up for 8 years, and her hypopituitarism gradually improved to a minimal level with only amenorrhea as the residual symptom. Recent MR imaging showed no residual mass at the region. Second patient was followed up for 15 months, and her diabetes insipidus is stable. MR imaging performed 5 months after the treatment showed marked reduction of the mass. These cases reemphasize the importance of histological diagnosis for lesions with similar neuroimaging appearances. Biopsy and low-dose irradiation are an effective treatment for this rare and essentially benign lesion, as opposed to attempting total removal of the mass.
Asunto(s)
Histiocitosis de Células de Langerhans/diagnóstico , Enfermedades Hipotalámicas/diagnóstico , Enfermedades de la Hipófisis/diagnóstico , Adolescente , Biopsia , Niño , Femenino , Histiocitosis de Células de Langerhans/patología , Histiocitosis de Células de Langerhans/radioterapia , Humanos , Enfermedades Hipotalámicas/patología , Enfermedades Hipotalámicas/radioterapia , Hipotálamo/patología , Imagen por Resonancia Magnética , Enfermedades de la Hipófisis/patología , Enfermedades de la Hipófisis/radioterapia , Hipófisis/patologíaRESUMEN
Hypopituitarism and diabetes insipidus are often idiopathic conditions. A retrospective study of 6 cases of diabetes insipidus and 8 cases of partial or global idiopathic anterior hypopituitarism has shown that MRI is of considerable value to detect abnormalities of the pituitary stalk or hypothalamo-pituitary "relay". On the basis of MRI findings, some cases of idiopathic hypopituitarism can now be grouped together in a new entity which may be called hypopituitarism due to neonatal transection of the pituitary stalk.
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Hipopituitarismo/patología , Hipotálamo/patología , Imagen por Resonancia Magnética , Adenohipófisis/patología , Neurohipófisis/patología , Adolescente , Adulto , Anciano , Diabetes Insípida/complicaciones , Femenino , Humanos , Hipopituitarismo/complicaciones , Sistema Hipotálamo-Hipofisario/patología , Lactante , Masculino , Persona de Mediana Edad , Enfermedades de la Hipófisis/patologíaRESUMEN
Endocrine disorders of the hypothalamus and pituitary gland are often caused by lesions which can be accurately detected and delineated by MRI, often with specific findings. MRI has emerged as the imaging modality of choice for pathology of the hypothalamus and other suprasellar structures, and for extrasellar extension of pituitary tumours. The advantage is mainly based on the high contrast resolution, vascular visualization without the need for intravascular contrast and direct multiplanar imaging capability inherent with the technique. CT, however, enjoys much wider availability and better spatial resolution at present. CT is still the method used to detect pituitary microadenomas in most centres, although high field-strength MR scanners and gadolinium enhancement permit thinner sections with improved sensitivity in certain institutes. Further advances in MRI technology are expected to broaden its usefulness in endocrinology.
Asunto(s)
Enfermedades Hipotalámicas/diagnóstico , Hipotálamo/patología , Imagen por Resonancia Magnética , Enfermedades de la Hipófisis/diagnóstico , Hipófisis/patología , Humanos , Enfermedades Hipotalámicas/patología , Enfermedades de la Hipófisis/patología , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/patologíaRESUMEN
Morphological features of pituitary disease are classified according to increased and decreased hormone production to allow clinical correlation with pathological processes. Increased hormone synthesis and secretion may be due to pituitary adenomas or carcinomas derived from the five hormone-secreting cell types, or to extrapituitary stimuli causing hypertrophy and hyperplasia of those cells. Various tumour-like conditions can mimic functioning adenomas. Rarely, no lesion is detected and intrinsic abnormalities of adenohypophyseal cells are implicated. Hypopituitarism can be selective or generalized. Diffuse hormone deficiency is usually attributable to tissue destruction by tumours, inflammatory or infiltrative conditions or vascular lesions. Congenital abnormalities of pituitary development may result in hypophyseal dysfunction. Hypothalamic abnormalities may cause generalized hypopituitarism or may involve only selective releasing factors and hormones. Feedback inhibition and receptor abnormalities may be implicated in pituitary hypofunction, and selective deficiencies may be the result of genetic abnormalities, immune reactions or toxic damage to one cell type.