ross/statdx
1
0
Fork 0
Code Issues Pull Requests Actions Packages Projects Releases Wiki Activity
Files
9c86b32c3bcd4ddeec568808e4d92e07111027e8
statdx/docs_md/articles/enlarged-pituitary-gland_65e54fd1-aecf-463c-bd85-97504c542051.md
T
Ross 9c86b32c3b .
2025-10-20 21:15:33 +01:00

21 KiB
Raw Blame History

title, docid, authors, breadcrumbs, category, documentVersionId, imageCount, lastUpdated, pageDescription, pageKeywords, pageTitle, enhancedTitle, type, references, breadcrumbs
title docid authors breadcrumbs category documentVersionId imageCount lastUpdated pageDescription pageKeywords pageTitle enhancedTitle type references breadcrumbs
Enlarged Pituitary Gland 65e54fd1-aecf-463c-bd85-97504c542051
key value
8d5254e9-8dda-478b-8f08-bdee97a32c79 Karen L. Salzman, MD, FACR
key value
5cff4116-3654-4b3a-bb75-5ebe0b8c9850 Anne G. Osborn, MD, FACR
name slug treeNodeId
Brain brain 6d8829f1-14d7-45af-8675-255189aa526a
name slug treeNodeId
Differential Diagnosis differential-diagnosis a7fdd139-664e-4bb8-8d18-400e4733ff60
name slug treeNodeId
Sella/Juxtasellar, Pineal Region sellajuxtasellar-pineal-region 5e38b9c1-3137-47e3-aa83-1fc82cb4099a
name slug treeNodeId
Anatomically Based Differentials anatomically-based-differentials 7a51b2ca-8fee-4c16-aff3-b7189f68ea60
name slug treeNodeId
Enlarged Pituitary Gland enlarged-pituitary-gland null
Brain 6624d150-d588-4aed-b1dd-621505522f70 23 01/27/23 Enlarged Pituitary Gland Brain, Differential Diagnosis, Sella/Juxtasellar, Pineal Region, Anatomically Based Differentials, Enlarged Pituitary Gland Enlarged Pituitary Gland | STATdx Enlarged Pituitary Gland DDX true
Brain
Differential Diagnosis
Sella/Juxtasellar, Pineal Region
Anatomically Based Differentials
Enlarged Pituitary Gland

title: "Enlarged Pituitary Gland" docid: "65e54fd1-aecf-463c-bd85-97504c542051" authors:

  • key: "8d5254e9-8dda-478b-8f08-bdee97a32c79" value: "Karen L. Salzman, MD, FACR"
  • key: "5cff4116-3654-4b3a-bb75-5ebe0b8c9850" value: "Anne G. Osborn, MD, FACR" breadcrumbs:
  • name: "Brain" slug: "brain" treeNodeId: "6d8829f1-14d7-45af-8675-255189aa526a"
  • name: "Differential Diagnosis" slug: "differential-diagnosis" treeNodeId: "a7fdd139-664e-4bb8-8d18-400e4733ff60"
  • name: "Sella/Juxtasellar, Pineal Region" slug: "sellajuxtasellar-pineal-region" treeNodeId: "5e38b9c1-3137-47e3-aa83-1fc82cb4099a"
  • name: "Anatomically Based Differentials" slug: "anatomically-based-differentials" treeNodeId: "7a51b2ca-8fee-4c16-aff3-b7189f68ea60"
  • name: "Enlarged Pituitary Gland" slug: "enlarged-pituitary-gland" treeNodeId: null category: "Brain" documentVersionId: "6624d150-d588-4aed-b1dd-621505522f70" imageCount: 23 lastUpdated: "01/27/23" pageDescription: "Enlarged Pituitary Gland" pageKeywords: "Brain, Differential Diagnosis, Sella/Juxtasellar, Pineal Region, Anatomically Based Differentials, Enlarged Pituitary Gland" pageTitle: "Enlarged Pituitary Gland | STATdx" enhancedTitle: "Enlarged Pituitary Gland" type: "DDX" references: true breadcrumbs:
  • "Brain"
  • "Differential Diagnosis"
  • "Sella/Juxtasellar, Pineal Region"
  • "Anatomically Based Differentials"
  • "Enlarged Pituitary Gland"

ESSENTIAL INFORMATION

  • Key Differential Diagnosis Issues

    • Not all "enlarged pituitary glands" abnormal - Size/height varies with sex, age - Children: 6 mm - Males, postmenopausal females: 8 mm - Young, menstruating females: 10-12 mm (can bulge upward) - Pregnant, postpartum, lactating females: 12-14 mm - Enhances strongly, uniformly - 15-20% have incidental cyst or nonfunctioning microadenoma (pituitary "incidentaloma")
    • Variants/mimics of "enlarged pituitary" - Pseudoenlargement secondary to unusually shallow bony sella or "kissing carotids" - Medially positioned cavernous internal carotid arteries ("kissing carotids") may make gland appear enlarged

  • Helpful Clues for Common Diagnoses

    • PituitaryHyperplasia - Can be normal (young, menstruating females) - Enlarged gland ± upward bulging - May be related to end-organ failure (i.e., hypothyroidism, ovarian) or neuroendocrine tumors
    • PituitaryMicroadenoma - May enlarge gland - Best identified with dynamic, contrast-enhanced MR
    • PituitaryMacroadenoma - Pituitary gland cannot be distinguished from mass - Enhances strongly, often heterogeneously - Typically sellar and suprasellar mass

  • Helpful Clues for Less Common Diagnoses

    • Lymphocytic Hypophysitis - May enlarge pituitary gland, ± infundibulum - May mimic macroadenoma - Common in pregnant and postpartum females - Different types: Autoimmune, granulomatous, IgG4 related, drug related (i.e., ipilimumab)
    • Neurosarcoid - Affects hypothalamic-pituitary axis in 50% - Diffusely enhancing lesion involving stalk ± gland
    • Langerhans Cell Histiocytosis - Loss of posterior pituitary bright spot - Enhancing infundibulum ± gland, hypothalamus - Young patients

  • Other Essential Information

    • Venous congestion (intracranial hypotension, dural arteriovenous fistula) can enlarge gland
    • Caution: Child or young adolescent male with "pituitary adenoma" most likely has pituitary hyperplasia; less likely LCH or germinoma, not adenoma - Evaluate for end-organ failure (e.g., hypothyroidism)
    • In child/young adult, consider pituitary hyperplasia, LCH, lymphocytic hypophysitis, anatomic variants
    • In adult, consider pituitary adenoma, hyperplasia, hypophysitis, neurosarcoid, lymphoma, metastatic disease

References

Selected References

  1. Bashari WA et al: Modern imaging in Cushing's disease. Pituitary. 25(5):709-12, 2022
  2. Chalif EJ et al: Pituitary adenoma in the elderly: surgical outcomes and treatment trends in the United States. J Neurosurg. 1-12, 2022
  3. Potorac I et al: Pituitary MRI features in acromegaly resulting from ectopic ghrh secretion from a neuroendocrine tumor: analysis of 30 cases. J Clin Endocrinol Metab. 107(8):e3313-20, 2022
  4. Villemaire A et al: Is systematic gadolinium injection relevant during MRI follow-up for non-functioning pituitary macroadenomas? J Neuroradiol. ePub, 2022
  5. Altshuler DB et al: Imaging errors in distinguishing pituitary adenomas from other sellar lesions. J Neuroophthalmol. 41(4):512-18, 2021
  6. Huang J et al: Noncontrast MRI protocol for selected pediatric pituitary endocrinopathies: a procedure with high diagnostic yield and potential to reduce anesthesia and gadolinium-based contrast exposure. AJNR Am J Neuroradiol. 42(10):1884-90, 2021
  7. Mittal PK et al: Role of imaging in the evaluation of male infertility. Radiographics. 160125, 2017
  8. Zamora C et al: Sellar and parasellar imaging. Neurosurgery. 80(1):17-38, 2017
  9. Kocova M et al: Diagnostic approach in children with unusual symptoms of acquired hypothyroidism. When to look for pituitary hyperplasia? J Pediatr Endocrinol Metab. 29(3):297-303, 2016
  10. Fujita A et al: IgG4-related disease of the head and neck: CT and MR imaging manifestations. Radiographics. 32(7):1945-58, 2012

Images

Selected Images

Sagittal T1 MR in a teenager with hypothyroidism shows marked enlargement of the pituitary gland related to pituitary hyperplasia. The pituitary gland returned to normal size after the hypothyroidism was treated. Pituitary Hyperplasia Sagittal T1 MR in a teenager with hypothyroidism shows marked enlargement of the pituitary gland related to pituitary hyperplasia. The pituitary gland returned to normal size after the hypothyroidism was treated.

Sagittal T1 MR in a teenager with hypothyroidism shows marked enlargement of the pituitary gland related to pituitary hyperplasia. The pituitary gland returned to normal size after the hypothyroidism was treated. Pituitary Hyperplasia Sagittal T1 MR in a teenager with hypothyroidism shows marked enlargement of the pituitary gland related to pituitary hyperplasia. The pituitary gland returned to normal size after the hypothyroidism was treated.

Coronal T1 C+ FS MR in a 55-year-old woman shows a mildly enlarged right pituitary gland related to a prolactin secreting microadenoma. Microadenomas are benign tumors of the adenohypophysis that are often seen best on dynamic contrast MR. Pituitary Microadenoma Coronal T1 C+ FS MR in a 55-year-old woman shows a mildly enlarged right pituitary gland related to a prolactin secreting microadenoma. Microadenomas are benign tumors of the adenohypophysis that are often seen best on dynamic contrast MR.

Coronal T1 C+ MR shows an enlarged pituitary gland related to a macroadenoma. Note displacement of the pituitary infundibulum to the contralateral side, typical of adenomas. Pituitary Macroadenoma Coronal T1 C+ MR shows an enlarged pituitary gland related to a macroadenoma. Note displacement of the pituitary infundibulum to the contralateral side, typical of adenomas.

Sagittal T1 C+ FS MR shows marked enlargement of the pituitary gland and infundibular stalk in this patient being treated with Ipilimumab for metastatic melanoma. The drug-related hypophysitis resolved after the therapy was discontinued. Lymphocytic Hypophysitis Sagittal T1 C+ FS MR shows marked enlargement of the pituitary gland and infundibular stalk in this patient being treated with Ipilimumab for metastatic melanoma. The drug-related hypophysitis resolved after the therapy was discontinued.

Sagittal T1 C+ MR shows a diffusely enlarged, enhancing pituitary gland in a young female with pituitary dysfunction. Neurosarcoid was diagnosed at resection. Imaging mimics the much more common pituitary adenoma. Neurosarcoid Sagittal T1 C+ MR shows a diffusely enlarged, enhancing pituitary gland in a young female with pituitary dysfunction. Neurosarcoid was diagnosed at resection. Imaging mimics the much more common pituitary adenoma.

Sagittal T1 C+ MR shows a uniformly enlarged, enhancing pituitary gland in this young adult with known Langerhans cell histiocytosis (LCH). LCH often presents with diabetes insipidus and loss of the normal posterior pituitary bright spot. Langerhans Cell Histiocytosis Sagittal T1 C+ MR shows a uniformly enlarged, enhancing pituitary gland in this young adult with known Langerhans cell histiocytosis (LCH). LCH often presents with diabetes insipidus and loss of the normal posterior pituitary bright spot.

Coronal T2 MR shows enlargement of the pituitary gland by a mass with extension to the left cavernous sinus . Lymphoma is often infiltrative, DWI positive, and diffusely enhances. Pituitary involvement is rare. Lymphoma, Primary CNS Coronal T2 MR shows enlargement of the pituitary gland by a mass with extension to the left cavernous sinus . Lymphoma is often infiltrative, DWI positive, and diffusely enhances. Pituitary involvement is rare.

Sagittal T1 MR shows a sagging midbrain with a decreased mamillopontine distance and a prominent pituitary gland . The optic chiasm is draped over the gland in this patient with intractable headaches. Diffuse dural enhancement is common in intracranial hypotension. Intracranial Hypotension Sagittal T1 MR shows a sagging midbrain with a decreased mamillopontine distance and a prominent pituitary gland . The optic chiasm is draped over the gland in this patient with intractable headaches. Diffuse dural enhancement is common in intracranial hypotension.

Additional Images

Sagittal T1 MR shows a sagging midbrain and a prominent pituitary gland . The optic chiasm is draped over the gland in this patient with postural hypotension and intractable headaches. Inferiorly displaced tonsils are common in intracranial hypotension. Intracranial Hypotension Sagittal T1 MR shows a sagging midbrain and a prominent pituitary gland . The optic chiasm is draped over the gland in this patient with postural hypotension and intractable headaches. Inferiorly displaced tonsils are common in intracranial hypotension.

Sagittal T1 MR shows a very shallow bony sella with the optic chiasm draped over the pituitary gland. The gland measures 9 mm, which is normal in 19-year-old women. Although the gland appears enlarged, it is actually a pseudoenlarged gland. Anatomic Variants (Small Sella Turcica, "Kissing Carotids") Sagittal T1 MR shows a very shallow bony sella with the optic chiasm draped over the pituitary gland. The gland measures 9 mm, which is normal in 19-year-old women. Although the gland appears enlarged, it is actually a pseudoenlarged gland.

Sagittal T1 MR shows a diffusely enlarged pituitary gland in a young female with pituitary dysfunction. Neurosarcoid was diagnosed at resection. Imaging mimics the much more common pituitary adenoma. Neurosarcoid Sagittal T1 MR shows a diffusely enlarged pituitary gland in a young female with pituitary dysfunction. Neurosarcoid was diagnosed at resection. Imaging mimics the much more common pituitary adenoma.

Coronal T1 C+ MR shows an enlarged pituitary gland with a heterogeneous macroadenoma. Pituitary apoplexy can be considered in patients with acute clinical features, including headache, visual defects &/or altered mental status, and a heterogeneous pituitary mass. Pituitary Macroadenoma Coronal T1 C+ MR shows an enlarged pituitary gland with a heterogeneous macroadenoma. Pituitary apoplexy can be considered in patients with acute clinical features, including headache, visual defects &/or altered mental status, and a heterogeneous pituitary mass.

Coronal T1 C+ MR shows a diffusely enlarged, enhancing pituitary gland in a 32-year-old female patient with pituitary dysfunction. Neurosarcoid was diagnosed at resection. Imaging mimics the much more common pituitary adenoma. Neurosarcoid Coronal T1 C+ MR shows a diffusely enlarged, enhancing pituitary gland in a 32-year-old female patient with pituitary dysfunction. Neurosarcoid was diagnosed at resection. Imaging mimics the much more common pituitary adenoma.

Coronal T1 C+ MR shows a uniformly enlarged, enhancing pituitary gland with upward displacement of the optic chiasm in this child with known LCH. LCH often presents with diabetes insipidus and loss of the normal posterior pituitary bright spot. Langerhans Cell Histiocytosis Coronal T1 C+ MR shows a uniformly enlarged, enhancing pituitary gland with upward displacement of the optic chiasm in this child with known LCH. LCH often presents with diabetes insipidus and loss of the normal posterior pituitary bright spot.

Sagittal T1 C+ FS MR in a 53-year-old man shows a mildly enlarged pituitary gland with a focal area of less enhancement related to a microadenoma. Microadenomas are benign tumors of the adenohypophysis that are often seen best on dynamic CEMR. Pituitary Microadenoma Sagittal T1 C+ FS MR in a 53-year-old man shows a mildly enlarged pituitary gland with a focal area of less enhancement related to a microadenoma. Microadenomas are benign tumors of the adenohypophysis that are often seen best on dynamic CEMR.

Sagittal T1 MR shows an enlarged pituitary gland that elevates the optic chiasm . This enlarged gland is almost isointense with the brain in this example of classic macroadenoma. Pituitary Macroadenoma Sagittal T1 MR shows an enlarged pituitary gland that elevates the optic chiasm . This enlarged gland is almost isointense with the brain in this example of classic macroadenoma.

Sagittal T1 C+ MR shows thickened, enhancing infundibulum and a slightly enlarged pituitary gland in a patient with known metastatic disease. Metastases to Gland/Stalk Sagittal T1 C+ MR shows thickened, enhancing infundibulum and a slightly enlarged pituitary gland in a patient with known metastatic disease.

Coronal T1 C+ MR shows an enhancing suprasellar mass in a patient with known metastatic lung cancer and diabetes insipidus. Metastases to Gland/Stalk Coronal T1 C+ MR shows an enhancing suprasellar mass in a patient with known metastatic lung cancer and diabetes insipidus.

Coronal T1 MR shows an enlarged pituitary gland with hyperintense focus . Preoperative diagnosis was Rathke cleft cyst. Granular cell tumor (type of pituicytoma) was found at surgery. Pituicytoma Coronal T1 MR shows an enlarged pituitary gland with hyperintense focus . Preoperative diagnosis was Rathke cleft cyst. Granular cell tumor (type of pituicytoma) was found at surgery.

Coronal T1 C+ MR shows an enlarged pituitary gland and stalk . Note dural thickening . Scan was normal after intravenous steroid administration. Pseudotumor, Intracranial Coronal T1 C+ MR shows an enlarged pituitary gland and stalk . Note dural thickening . Scan was normal after intravenous steroid administration.

Coronal T1 C+ MR shows a mass diffusely infiltrating the pituitary gland . Extension into the cavernous sinus helps identify more aggressive pathology. Lymphoma, Primary CNS Coronal T1 C+ MR shows a mass diffusely infiltrating the pituitary gland . Extension into the cavernous sinus helps identify more aggressive pathology.

Coronal T1 C+ MR shows a physiologically enlarged pituitary gland in this 28-year-old lactating woman. The gland measures nearly 12 mm in height. Follow-up scan 1 year later was normal. Pituitary Hyperplasia Coronal T1 C+ MR shows a physiologically enlarged pituitary gland in this 28-year-old lactating woman. The gland measures nearly 12 mm in height. Follow-up scan 1 year later was normal.

Coronal T1 C+ MR in a 51-year-old man shows a mildly enlarged pituitary gland measuring 11 mm in height. Note the faint area of slightly less enhancement . An 8-mm microadenoma was found at surgery. Pituitary Microadenoma Coronal T1 C+ MR in a 51-year-old man shows a mildly enlarged pituitary gland measuring 11 mm in height. Note the faint area of slightly less enhancement . An 8-mm microadenoma was found at surgery.

Reference in New Issue View Git Blame Copy Permalink