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Welby JP, Madhavan AA, Campeau NG, Eckel LJ, Silvera VM, Guerin JB. Dorsoventral splitting of the infundibulum in a child with pituitary hypoplasia. Radiol Case Rep 2023; 18:2754-2757. [PMID: 37334326 PMCID: PMC10275733 DOI: 10.1016/j.radcr.2023.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/01/2023] [Accepted: 05/13/2023] [Indexed: 06/20/2023] Open
Abstract
Pituitary development arises from ectodermal tissue creating Rathke's pouch and ultimately the adenohypophysis anteriorly whereas neuroectodermal tissue arising from the diencephalon creates the neurohypophysis posteriorly. Alterations in pituitary development can lead to hormonal dysregulation and dysfunction. Following clinical suspicion of pituitary endocrinopathy, MRI plays a vital role in identifying and characterizing underlying structural abnormalities of the pituitary gland, as well as any associated extrapituitary findings. Here we report a case of an 18-month-old female presenting with short stature and growth hormone deficiency. MRI was notable for a shallow sella turcica, a hypoplastic adenohypophysis, thin pituitary stalk, and ectopic neurohypophysis. Interestingly, the pituitary stalk was noted to split dorsoventrally with a split pituitary bright spot and T1 hypointense lobe hypothesized to represent separation of the posterior pituitary lobes.
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2
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Alkhyeli F, Boharoon H, Almarzouqi A. Severe Hyponatremia in a 46-Year-Old Female With Pituitary Stalk Duplication and Primary Empty Sella Syndrome. Cureus 2023; 15:e43851. [PMID: 37736451 PMCID: PMC10510566 DOI: 10.7759/cureus.43851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
Pituitary duplication is a rare congenital malformation. It has been mainly reported in the pediatric and neonatal population, with few reported cases in the adult population. In this case report, we discuss the presentation of an adult female patient with pituitary stalk duplication and primary empty sella (PES). A 46-year-old South Asian female presented with severe euvolemic hyponatremia. Initial investigation showed low serum osmolality, high urine osmolality, high urinary sodium concentration, and normal chest X-ray. On physical examination, the patient had underdeveloped secondary sexual characteristics. Laboratory tests showed low follicle-stimulating hormone, luteinizing hormone, and estradiol. Prolactin was moderately elevated, morning cortisol was low, adrenocorticotropic hormone (ACTH) was within the lower normal range, ACTH dynamic test was suboptimal, and insulin-like growth factor 1 was low. MRI showed empty sella with duplication of the pituitary stalk and third ventricle sagging. Pituitary stalk duplication is a rare congenital malformation that can be associated with other craniofacial abnormalities. Here, we describe the occurrence of pituitary stalk duplication with PES. It is not known if the two conditions are associated with each other. However, we speculate that the duplication of the stalk might have altered the normal anatomy of the aperture in the sellar diaphragm creating a space for the third ventricle to sag or herniate, as well as compressing the pituitary gland.
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Affiliation(s)
- Fatima Alkhyeli
- Medical Education, Sheikh Khalifa Medical City, Abu Dhabi, ARE
| | - Hessa Boharoon
- Endocrinology, Sheikh Khalifa Medical City, Abu Dhabi, ARE
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Pascual JM, Carrasco R, Barrios L, Prieto R. Duct-like Recess in the Infundibular Portion of Third Ventricle Craniopharyngiomas: An MRI Sign Identifying the Papillary Type. AJNR Am J Neuroradiol 2022; 43:1333-1340. [PMID: 35953277 PMCID: PMC9451635 DOI: 10.3174/ajnr.a7602] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/20/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Papillary craniopharyngiomas (PCPs) are particularly challenging lesions requiring accurate diagnosis to plan the best therapy. Our aim was to define a narrow duct-like recess identified on MR imaging at the base of papillary craniopharyngiomas with a strict third ventricle location. MATERIALS AND METHODS A duct-like recess at the infundibular portion of craniopharyngiomas was observed on conventional T1WI and T2WI in 3 strict third ventricle papillary craniopharyngiomas in our craniopharyngioma series (n = 125). We systematically investigated this finding on the MR imaging of 2582 craniopharyngiomas and 10 other categories of third ventricle tumors (n = 690) published in the modern era (1986-2020). The diagnostic value and significance of this finding are addressed. RESULTS The duct-like recess was recognized in 52 papillary craniopharyngiomas, including 3 of our own cases, as a narrow canal-shaped cavity invaginated at the tumor undersurface, just behind the optic chiasm. This structure largely involves papillary craniopharyngiomas with a strict third ventricle topography (96%), follows the same diagonal trajectory as the pituitary stalk, and finishes at a closed end. The duct-like recess sign identifies the papillary craniopharyngioma type with a specificity of 100% and a sensitivity of 38% in the overall craniopharyngioma population. This finding can also establish the strictly intra-third ventricle location of the lesion with a 90% specificity and 33% sensitivity. These recesses appear as hypointense circular spots on axial/coronal T1WI and T2WI. Their content apparently corresponds to CSF freely flowing within the suprasellar cistern. CONCLUSIONS The presence of a duct-like recess at the infundibular portion of a third ventricle tumor represents a distinctive hallmark of papillary craniopharyngiomas that can be used as a simple MR imaging sign to reliably diagnose these lesions.
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Affiliation(s)
- J M Pascual
- From the Department of Neurosurgery (J.M.P), La Princesa University Hospital, Madrid, Spain
| | - R Carrasco
- Department of Neurosurgery (R.C.), Ramón y Cajal University Hospital, Madrid, Spain
| | - L Barrios
- Statistics Department (L.B.), Computing Center, Spanish National Research Council, Madrid, Spain
| | - R Prieto
- Department of Neurosurgery (R.P.), Puerta de Hierro University Hospital, Madrid, Spain
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Pascual JM, Prieto R, Carrasco R, Barrios L. Duct-like diverticulum at the base of third ventricle tumors: a morphological signature diagnostic of papillary craniopharyngioma. Neurosurg Rev 2022; 45:3361-3379. [PMID: 35982344 DOI: 10.1007/s10143-022-01848-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/02/2022] [Accepted: 08/10/2022] [Indexed: 11/27/2022]
Abstract
This study describes and characterizes a narrow, hollow tubular structure, termed as duct-like diverticulum (DV), found specifically at the basal midline of papillary craniopharyngiomas (PCPs) located within the third ventricle (3V). The presence of this structure was systematically investigated on autopsy studies and magnetic resonance imaging (MRI) scans of 3536 craniopharyngioma (CP) cases published in the medical literature from 1911 to 2021, as well as in other twelve 3V tumor categories (n = 1470 cases). A basal DV was observed in a total of 50 PCPs, including two of our own cases. This DV corresponds to a tubular-shaped recess invaginated at the midline bottom of the tumor, following the same angled trajectory as the pituitary stalk. It can be easily seen as a hypointense linear structure on T1- and T2-weighted MRI scans, with two main length types: long DVs (74%), which reach the tumor center, and short DVs (26%), which penetrate the tumor only a few millimeters. The DV sign identifies the papillary CP type with a specificity of 100% and a sensitivity of 33% in the overall CP population. This finding also serves to establish the strictly intra-3V location of the lesion with a 95% specificity and 42% sensitivity among papillary CPs. No similar basal DV was found in adamantinomatous CPs nor among other categories of strictly 3V tumors. Consequently, the presence of a diverticulum in a 3V tumor represents a morphological signature pathognomonic of the papillary type and a valuable sign to reliably define the strictly 3V topography.
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Affiliation(s)
- José María Pascual
- Department of Neurosurgery, La Princesa University Hospital, C/ Diego de León 62, 28006, Madrid, Spain.
| | - Ruth Prieto
- Department of Neurosurgery, Puerta de Hierro University Hospital, Madrid, Spain
| | - Rodrigo Carrasco
- Department of Neurosurgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - Laura Barrios
- Statistics Department, Computing Center, C.S.I.C., Madrid, Spain
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Persisting embryonal infundibular recess (PEIR) and transsphenoidal-transsellar encephaloceles: distinct entities or constituents of one continuum? Childs Nerv Syst 2022; 38:1059-1067. [PMID: 35192025 DOI: 10.1007/s00381-022-05467-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/29/2022] [Indexed: 11/03/2022]
Abstract
Persisting embryonal infundibular recess (PEIR) is a very rare anomaly of the floor of the third ventricle in which the embryonic morphology of the infundibular recess (IR) persists. The exact underlying mechanism of development of PEIR is unknown, and the anomaly has been reported as an isolated finding or in association with other conditions. On the other hand, trans-sphenoidal encephaloceles are the rarest form of basal encephaloceles. The trans-sphenoidal trans-sellar encephalocele (TSE) is the least common variant in which the pituitary gland, pituitary stalk, optic pathways, parts of the third ventricle and IR may be present within the encephalocele. We recently treated one patient with TSE. Based on the observed morphological similarity of the IR in our patient and in the published cases of PEIR, we reviewed the literature in order to validate the hypothesis that PEIR and TSE may possibly belong to one spectrum of malformations. Across the published reports, the morphology of the IR in TSE is very closely similar to PEIR. Moreover, radiological, patho-anatomical, and embryological evidence is in support to our hypothesis that PEIR and TSE are most likely the two extremes of the same continuum of malformations.
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Duplication of the Pituitary Gland: CT, MRI and DTI Findings and Updated Review of the Literature. Brain Sci 2022; 12:brainsci12050574. [PMID: 35624961 PMCID: PMC9139653 DOI: 10.3390/brainsci12050574] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 02/05/2023] Open
Abstract
Duplication of the pituitary gland (DPG) is an extremely rare malformation. DPG is associated with a wide variety of midline and central nervous system malformations (DPG-plus syndrome). We present the computed tomography (CT), magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) findings of a rare case of DPG with associated tuberomammillary fusion resulting in a hypothalamic mass-like configuration, oropharyngeal teratoma, cleft palate, hypertelorism, duplicated/broad sella, duplication/low bifurcation of the basilar artery, and craniovertebral midline anomalies. Qualitative interpretation of DTI yielded normal white matter organization of the brain. The duplication of the prechordal plate and the rostral end of the notochordal plate/notochord is thought to be the main factor leading to a duplication of the pituitary primordium and resulting in the formation of two morphologically normal glands. The time of induction of the teratogenic influence, the extent of the prechordal plate and notochordal plate/notochord abnormalities, and the faulty interactions are believed to be the reason for the wide spectrum of associated midline abnormalities.
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Pascual JM, Prieto R, Carrasco R, Barrios L. Basal Recess in Third Ventricle Tumors: A Pathological Feature Defining a Clinical-Topographical Subpopulation of Papillary Craniopharyngiomas. J Neuropathol Exp Neurol 2022; 81:330-343. [PMID: 35472085 DOI: 10.1093/jnen/nlac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study investigates the presence of a hollow recess at the midline undersurface of tumors primarily localized within the third ventricle (3V). This structure was originally identified by magnetic resonance imaging (MRI) of 6 3V craniopharyngiomas (CPs) from our series and was then methodically scrutinized in autopsy studies (n = 1091) and MRI scans (n = 5558) of CPs and in 1251 3V tumors reported in the medical literature from 1839 to 2021. A recess at the tumor base was identified in 110 CPs, 95 with a verified papillary histology (papillary craniopharyngioma [PCP]) and 15 with typical gross appearance of PCP. Topographically, 90 tumors were strictly within the 3V (82%); 20 developed at the infundibulo-tuberal region of the 3V floor (18%). Morphologically, 2 main types of recess were identified: (i) a long, narrow recess with either a duct-like or a tubular shape that reached the central region of the CP (n = 47, 42.5%); and (ii) a short recess extending only a few millimeters into the lesion, either with a duct-like or a shallow cleft-like morphology (n = 63, 57.5%). Thus, the presence of a basal recess represents a pathological hallmark of a subpopulation of 3V PCPs. The presumed nature and diagnostic significance of this novel finding is comprehensively addressed.
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Affiliation(s)
- José María Pascual
- Department of Neurosurgery, La Princesa University Hospital, Madrid, Spain
| | - Ruth Prieto
- Department of Neurosurgery, Puerta de Hierro University Hospital, Madrid, Spain
| | - Rodrigo Carrasco
- Department of Neurosurgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - Laura Barrios
- Statistics Department, Computing Center, C.S.I.C. Madrid, Spain
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Pascual JM, Prieto R, Rosdolsky M. Craniopharyngiomas primarily affecting the hypothalamus. HANDBOOK OF CLINICAL NEUROLOGY 2021; 181:75-115. [PMID: 34238481 DOI: 10.1016/b978-0-12-820683-6.00007-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The concept of craniopharyngiomas (CPs) primarily affecting the hypothalamus, or "hypothalamic CPs" (Hy-CPs), refers, in a restrictive sense, to the subgroup of CPs originally developing within the neural tissue of the infundibulum and tuber cinereum, the components of the third ventricle floor. This subgroup, also known as infundibulo-tuberal CPs, largely occupies the third ventricle and comprises up to 40% of this pathological entity. The small subgroup of strictly intraventricular CPs (5%), lesions wholly developed within the third ventricle above an anatomically intact third ventricle floor, can also be included within the Hy-CP category. The remaining types of sellar and/or suprasellar CPs may compress or invade the hypothalamic region during their growth but will not be considered in this review. Hy-CPs predominantly affect adults, causing a wide range of symptoms derived from hypothalamic dysfunction, such as adiposogenital dystrophy (Babinski-Fröhlich's syndrome), diabetes insipidus (DI), abnormal diurnal somnolence, and a complex set of cognitive (dementia-like, Korsakoff-like), emotional (rage, apathy, depression), and behavioral (autism-like, psychotic-like) disturbances. Accordingly, Hy-CPs represent a neurobiological model of psychiatric disorders caused by a lesion restricted to the hypothalamus. The vast majority (90%) of squamous-papillary CPs belong to the Hy-CP category. Pathologically, most Hy-CPs present extensive and strong adhesions to the surrounding hypothalamus, usually formed of a thick band of gliotic tissue encircling the central portion of the tumor ("ring-like" attachment) or its entire boundary ("circumferential" attachment). CPs with these severe adhesion types associate high surgical risk, with morbidity and mortality rates three times higher than those for sellar/suprasellar CPs. Consequently, radical surgical removal of Hy-CPs cannot be generally recommended. Rather, Hy-CPs should be accurately classified according to an individualized surgery-risk stratification scheme considering patient age, CP topography, presence of hypothalamic symptoms, tumor size, and, most importantly, the CP-hypothalamus adhesion pattern.
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Affiliation(s)
- José María Pascual
- Department of Neurosurgery, La Princesa University Hospital, Madrid, Spain.
| | - Ruth Prieto
- Department of Neurosurgery, Puerta de Hierro University Hospital, Madrid, Spain
| | - Maria Rosdolsky
- Independent Medical Translator, Jenkintown, PA, United States
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Ahmed A, Ehsan AN, Mubarak F, Shamim MS, Batool M, Banu S. UNIQUE PRESENTATION OF DUPLICATION OF THE PITUITARY GLAND-PLUS SYNDROME. AACE Clin Case Rep 2020; 6:e357-e360. [PMID: 33244503 DOI: 10.4158/accr-2019-0487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/25/2020] [Indexed: 11/15/2022] Open
Abstract
Objective To shed light on a unique presentation of duplication of the pituitary gland (DPG)-plus syndrome. Methods We present the case report gathered from the patient. Results This patient uniquely had DPG-plus syndrome with a concurrent dermoid cyst. Conclusion DPG is a very rare developmental anomaly and there are not many case reports published in the literature. The presence of DPG with dermoid cyst in our patient has not been reported previously. This case report discusses the various presentations of the syndrome and also provides an overview of investigations and management of these patients.
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10
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Vinayagamani S, Thomas B, Gohil J, Sekar S, Nair P, Kesavadas C. Bipartite craniopharyngeal canal with a lipoma and cephalocele: a previously unreported entity. Acta Neurochir (Wien) 2019; 161:355-359. [PMID: 30637485 DOI: 10.1007/s00701-018-03795-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 12/27/2018] [Indexed: 11/29/2022]
Abstract
A 13-year-old male child was evaluated for headache and visual deterioration; he underwent routine MRI imaging which revealed a large craniopharyngeal canal, divided by an abnormal bony septum giving a bipartite appearance of the canal, with a lipoma and cephalocele on either side of the septum. The child had undergone a previous surgery for cleft palate repair at the age of 7. The child had normal pituitary function inspite of nonvisualization of pituitary gland in MRI. To best our knowledge, this is the first case with such a variation. We have also discussed the possible embryological hypothesis for this previously unreported entity. Knowledge about this rare variant might have surgical relevance in selected cases.
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Affiliation(s)
- S Vinayagamani
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Room no 318, Srishty building, SCTIMST Staff Quarters, Poondi Road, Kumarapuram Junction, Medical college (P.O), Trivandrum, Kerala, 695011, India.
| | - Bejoy Thomas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Room no 318, Srishty building, SCTIMST Staff Quarters, Poondi Road, Kumarapuram Junction, Medical college (P.O), Trivandrum, Kerala, 695011, India
| | - Jaypalsinh Gohil
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Sabarish Sekar
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Room no 318, Srishty building, SCTIMST Staff Quarters, Poondi Road, Kumarapuram Junction, Medical college (P.O), Trivandrum, Kerala, 695011, India
| | - Prakash Nair
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Chandrasekharan Kesavadas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Room no 318, Srishty building, SCTIMST Staff Quarters, Poondi Road, Kumarapuram Junction, Medical college (P.O), Trivandrum, Kerala, 695011, India
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11
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Shires CB, Giurintano JP, McLevy-Bazzanella J, Thompson J. Anterior skull base duplication requiring delivery via EXIT procedure: A case report. Int J Pediatr Otorhinolaryngol 2018; 115:24-26. [PMID: 30368386 DOI: 10.1016/j.ijporl.2018.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/12/2018] [Accepted: 09/12/2018] [Indexed: 11/28/2022]
Abstract
Duplication of the anterior skull base structures is an extremely rare malformation of failed midline blastogenesis. We present the case of a child with an obstructive oral cavity mass diagnosed on prenatal imaging. The child was successfully delivered by EXIT procedure, a tracheotomy was performed, and postnatal imaging demonstrated an array of craniofacial malformations, including complete duplication of the maxilla, pituitary glands, aqueducts of Sylvius, and basilar arteries. The child underwent excision of the duplicate maxilla, resulting in a wide cleft palate that will be repaired at a future date.
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Affiliation(s)
- Courtney B Shires
- University of Tennessee Health Science Center, Department of Otolaryngology - Head and Neck Surgery, 910 Madison Avenue Suite 430, Memphis, TN, 38163, USA.
| | - Jonathan P Giurintano
- University of Tennessee Health Science Center, Department of Otolaryngology - Head and Neck Surgery, 910 Madison Avenue Suite 430, Memphis, TN, 38163, USA.
| | - Jennifer McLevy-Bazzanella
- University of Tennessee Health Science Center, Department of Otolaryngology - Head and Neck Surgery, 910 Madison Avenue Suite 430, Memphis, TN, 38163, USA.
| | - Jerome Thompson
- University of Tennessee Health Science Center, Department of Otolaryngology - Head and Neck Surgery, 910 Madison Avenue Suite 430, Memphis, TN, 38163, USA.
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12
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Belotti F, Lupi I, Cosottini M, Ambrosi C, Gasparotti R, Bogazzi F, Fontanella MM, Doglietto F. Persisting Embryonal Infundibular Recess (PEIR): Two Case Reports and Systematic Literature Review. J Clin Endocrinol Metab 2018; 103:2424-2429. [PMID: 29788483 DOI: 10.1210/jc.2018-00437] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 04/27/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT The persisting embryonal infundibular recess (PEIR) is a rare anomaly of the floor of the third ventricle with a debated pathogenesis. It can be a cause of misdiagnosis in the case of cystic lesions of the sellar and suprasellar area. OBJECTIVE To describe two recently evaluated cases and provide a systematic literature review. EVIDENCE ACQUISITION AND CASE DESCRIPTIONS PEIR has been previously reported in six adult patients. Because in some cases it was associated with hydrocephalus and/or empty sella, a possible role of altered intracranial pressure in PEIR formation has been postulated. We evaluated two female patients, aged 34 and 50 years, referred to the Pituitary Surgery Clinic of the University of Brescia with the diagnosis of a sellar cyst and craniopharyngioma, respectively. Endocrine screening and visual field testing were normal. No signs of hydrocephalus or empty sella, as well as other indirect signs of intracranial hypertension, were visible on MRI scans. After a multidisciplinary reevaluation, diagnosis of PEIR was made in both cases. Both patients are followed but have not developed any disturbance related to the PEIR in the following 18 months. CONCLUSIONS PEIR is a rare condition, probably unrecognized and the result of dysembriogenesis, which should be included in the differential diagnosis of cystic sellar lesions. Imaging features (funnel pituitary stalk and cyst in the sella) appear pathognomonic. A normal endocrine evaluation might help in the diagnosis and warrants conservative treatment.
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Affiliation(s)
- Francesco Belotti
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Isabella Lupi
- Endocrinology, Department of Clinical and Experimental Medicine, University Hospital, Pisa, Italy
| | - Mirco Cosottini
- Neuroradiology, Department of Translational Research and New Technologies in Medicine and Surgery, University Hospital, Pisa, Italy
| | - Claudia Ambrosi
- Neuroradiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Roberto Gasparotti
- Neuroradiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Fausto Bogazzi
- Endocrinology, Department of Clinical and Experimental Medicine, University Hospital, Pisa, Italy
| | - Marco M Fontanella
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Doglietto
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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13
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Surgical Management of Duplication of the Pituitary Gland-Plus Syndrome With Epignathus, Cleft Palate, Duplication of Mandible, and Lobulated Tongue. J Craniofac Surg 2017; 28:e141-e144. [DOI: 10.1097/scs.0000000000003324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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14
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Zamora C, Castillo M. Sellar and Parasellar Imaging. Neurosurgery 2016; 80:17-38. [DOI: 10.1093/neuros/nyw013] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 10/18/2016] [Indexed: 11/13/2022] Open
Abstract
Abstract
The skull base is a complex anatomical region that harbors many important neurovascular structures in a relatively confined space. The pathology that can develop at this site is varied, and many disease processes may present with similar clinical and neuroimaging findings. While computed tomography maintains a role in the evaluation of many entities and can, for instance, delineate osseous erosion with great detail and characterize calcified tumor matrices, magnetic resonance imaging (MRI) is the mainstay in the neuroimaging assessment of most pathology occurring at the skull base. Various MRI sequences have proven to be robust tools for tissue characterization and can provide information on the presence of lipids, paramagnetic and diamagnetic elements, and tumor cellularity, among others. In addition, currently available MRI techniques are able to generate high spatial resolution images that allow visualization of cranial nerves and their involvement by adjacent pathology. The information obtained from such examinations may aid in the distinction of these disease processes and in the accurate delineation of their extent prior to biopsy or treatment planning.
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15
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Abstract
Duplication of the pituitary gland (DPG) is a very rare developmental anomaly that is often associated with other anomalies – the DPG-plus syndrome and occurs due to splitting of the rostral notochord and prechordal plate during blastogenesis. DPG with the constellation of associated anomalies as in our patient has not been reported previously. This article illustrates the importance of imaging the brain in all patients with obvious midline facial anomalies and the complementary role of MRI and CT in such cases.
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Affiliation(s)
- Debraj Sen
- Department of Radiodiagnosis, Military Hospital, Amritsar, India
| | - Vijinder Arora
- Department of Radiodiagnosis, Nijjer Scan and Diagnostic Centre, Amritsar, India
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16
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Lee JY, Yoon HK, Khang SK. Giant hypothalamic hamartoma associated with an intracranial cyst in a newborn. Ultrasonography 2016; 35:353-8. [PMID: 27101982 PMCID: PMC5040142 DOI: 10.14366/usg.15080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 11/16/2022] Open
Abstract
We report the case of a giant hypothalamic hamartoma with a large intracranial cyst
in a neonate. On ultrasonography, the lesion presented as a lobulated, mass-like
lesion with similar echogenicity to the adjacent brain parenchyma, located anterior
to the underdeveloped and compressed left temporal lobe, and presenting as an
intracranial cyst in the left cerebral convexity without definite internal
echogenicity or septa. The presence of a hypothalamic hamartoma and intracranial
neurenteric cyst were confirmed by surgical biopsy. The association of a giant
hypothalamic hamartoma and a neurenteric cyst is rare. Due to the rarity of this
association, the large size of the intracranial cyst, and the resulting distortion in
the regional anatomy, the diagnosis of the solid mass was not made correctly on
prenatal high-resolution ultrasonography.
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Affiliation(s)
- Joo Yeon Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye-Kyung Yoon
- Department of Radiology, Kangwon National University Hospital, Chuncheon, Korea
| | - Shin Kwang Khang
- Department of Pathology, University of Ulsan College of Medicine, Seoul, Korea
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17
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Azurara L, Marçal M, Vieira F, Tuna ML. DPG-plus syndrome: new report of a rare entity. BMJ Case Rep 2015; 2015:bcr-2015-212416. [PMID: 26564114 DOI: 10.1136/bcr-2015-212416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pituitary gland duplication is a particularly rare finding. Different theories have been proposed to explain its pathogenesis, however, this phenomenon is not yet totally understood. Recently, duplication of the pituitary gland (DPG)-plus syndrome has been described, associating DPG with other blastogenic defects. We present the clinical and imaging findings of a newborn girl with DPG, associated with multiple other midline anomalies, including a nasopharyngeal teratoma, palate cleft deformity, bifid nasal bridge, tongue and uvula, hypoplasia of the basis pontis and corpus callosum, duplication of the basilar artery and hypothalamic hamartoma. We describe our patient's multidisciplinary team approach and emphasise the importance of reporting upcoming cases, in order to give more insight into the understanding of this complex entity.
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Affiliation(s)
- Laura Azurara
- Department of Pediatrics, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Mónica Marçal
- Department of Pediatrics, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Filipa Vieira
- Department of Pediatrics, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Madalena Lopo Tuna
- Department of Pediatrics, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
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18
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Magnetic resonance imaging of sellar and juxtasellar abnormalities in the paediatric population: an imaging review. Insights Imaging 2015; 6:241-60. [PMID: 25794595 PMCID: PMC4376809 DOI: 10.1007/s13244-015-0401-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/11/2015] [Accepted: 02/17/2015] [Indexed: 12/18/2022] Open
Abstract
The sellar and juxtasellar regions in the paediatric population are complex both anatomically and pathologically, with magnetic resonance imaging (MRI) being the "gold standard" imaging modality due to the high contrast of detail. Assessment requires a detailed understanding of the anatomy, embryology, pathophysiology and normal signal characteristics of the pituitary gland and surrounding structures in order to appropriately characterise abnormalities. This article aims to provide an overview of the imaging characteristics of developmental/congenital and acquired disease processes which affect the sellar and juxtasellar region in the paediatric population. Main Messages • The sellar region is anatomically complex and covers a wide pathology spectrum. • MRI is the key imaging modality to assess sellar and juxtasellar pathology. • Numerous developmental anomalies may not be discovered until adulthood. • Knowledge of pathology alerts and guides the clinician towards appropriate management.
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Morlino S, Castori M, Servadei F, Laino L, Silvestri E, Grammatico P. Oropharyngeal teratoma, oral duplication, cervical diplomyelia and anencephaly in a 22-week fetus: A review of the craniofacial teratoma syndrome. ACTA ACUST UNITED AC 2014; 103:554-66. [PMID: 25360518 DOI: 10.1002/bdra.23327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Oropharyngeal teratoma may occur by itself or together with other craniofacial malformations, most commonly cleft palate. Oropharyngeal teratoma may be also seen in association with frontonasal dysplasia and/or various degrees of craniofacial duplication. The nosology of these sporadic disorders is poorly defined. CASE AND REVIEW We report on a 22-week fetus with a protruding nasopharyngeal teratoma, partial oral duplication, anencephaly, multiple costo-vertebral segmentation defects, and cervical diplomyelia. A review of the literature identified 48 patients published from 1931 to 2013 with co-existing clefting and duplication anomalies of the cephalic pole. Thoracic and abdominal midline anomalies were reported 13 times. CONCLUSION The term "craniofacial teratoma syndrome" is introduced to define this phenotype as a recognizable developmental field defect of the cephalic pole. Developmental pathogenesis is discussed with a focus on pleiotropy and stereotaxis. The observation of midline findings suggestive of holoprosencephaly in a few previously reported cases suggests a role for the sonic hedgehog signaling pathway in this malformation pattern.
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Affiliation(s)
- Silvia Morlino
- Division of Medical Genetics, Department of Molecular Medicine, Sapienza University, San Camillo-Forlanini Hospital, Rome, Italy
| | - Marco Castori
- Division of Medical Genetics, Department of Molecular Medicine, Sapienza University, San Camillo-Forlanini Hospital, Rome, Italy
| | - Francesca Servadei
- Unit of Fetal and Neonatal Pathology, Division of Pathology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Luigi Laino
- Division of Medical Genetics, Department of Molecular Medicine, Sapienza University, San Camillo-Forlanini Hospital, Rome, Italy
| | - Evelina Silvestri
- Unit of Fetal and Neonatal Pathology, Division of Pathology, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Paola Grammatico
- Division of Medical Genetics, Department of Molecular Medicine, Sapienza University, San Camillo-Forlanini Hospital, Rome, Italy
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Abele TA, Salzman KL, Harnsberger HR, Glastonbury CM. Craniopharyngeal canal and its spectrum of pathology. AJNR Am J Neuroradiol 2013; 35:772-7. [PMID: 24184521 DOI: 10.3174/ajnr.a3745] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The craniopharyngeal canal is a rare, well-corticated defect through the midline of the sphenoid bone from the sellar floor to the anterosuperior nasopharyngeal roof. We reviewed a series of craniopharyngeal canals to determine a system of classification that might better our understanding of this entity, highlight the range of associated pathologic conditions, and optimize patient treatment. MATERIALS AND METHODS Available MR imaging, CT, and clinical data (from 1989-2013) of 29 patients (10 female, 15 male, 4 unknown; median age, 4 years; age range, 1 day-65 years) with craniopharyngeal canals were retrospectively examined. Qualitative assessment included orthotopic or ectopic adenohypophysis and the presence of a tumor and/or cephalocele. The midpoint anteroposterior diameter was measured. Clinical and imaging data were evaluated for pituitary dysfunction and accompanying anomalies. RESULTS Craniopharyngeal canals were qualitatively separated into 3 types: incidental canals (type 1); canals with ectopic adenohypophysis (type 2); and canals containing cephaloceles (type 3A), tumors (type 3B), or both (type 3C), including pituitary adenoma, craniopharyngioma, dermoid, teratoma, and glioma. Quantitative evaluation showed a significant difference (P < .0001) in the anteroposterior diameters of type 1 canals (median, 0.8; range, 0.7-1.1 mm), type 2 canals (median, 3.9, range, 3.5-4.4 mm), and type 3 canals (median, 9.0; range, 5.9-31.0 mm) imparting small, medium, and large descriptors. Canals with cephaloceles all contained an ectopic adenohypophysis. The craniopharyngeal canals were associated with pituitary dysfunction (6/29) and congenital anomalies (8/29). CONCLUSIONS Accurate diagnosis and classification of craniopharyngeal canals are valuable to characterize lesions requiring surgery, identify patients with potential pituitary dysfunction, and avoid iatrogenic hypopituitarism or CSF leak during surgical resection of nasopharyngeal masses.
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Affiliation(s)
- T A Abele
- From the Department of Radiology (T.A.A., K.L.S., H.R.H.), University of Utah, Salt Lake City, Utah
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Abstract
Nasal hamartomas are rare congenital lesions. We describe a case of nasal hamartoma associated with pituitary duplication and other midline anomalies. A 40-year-old female with a history of breast cancer presented with nasal obstruction. Computed tomography and magnetic resonance imaging revealed a mass arising from the nasal septum, as well as duplication of the pituitary and a skull base canal that extended from the margin of the left pituitary fossa to the nasal mass. The mass was subsequently resected via a transnasal endoscopic approach and histology confirmed the presence of hamartoma. Nasal hamartomas are benign lesions that can be associated with other midline anomalies, such as duplicated pituitary, and can be managed conservatively.
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Katorza E, Bault JP, Gilboa Y, Yinon Y, Hoffmann C, Achiron R. Prenatal visualization of the pituitary gland using 2- and 3-dimensional sonography: comparison to prenatal magnetic resonance imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:1675-1680. [PMID: 23011631 DOI: 10.7863/jum.2012.31.10.1675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The pituitary gland is crucially important in the function of the endocrine axis. So far, antenatal depiction of the pituitary gland was possible only using magnetic resonance imaging. We describe antenatal visualization of the pituitary gland using 2- and 3-dimensional sonography. The appearance of the gland on sonography seems to be superior compares to prenatal magnetic resonance imaging. In cases with midline anomalies of the brain, face, or cranium, depiction of the pituitary gland is feasible and recommended.
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Affiliation(s)
- Eldad Katorza
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, 52621 Tel-Hashomer, Israel.
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23
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Usta Y, Sakha F, White W, Little A, Knecht L. Duplicated Pituitary Gland and Odontoid Process. Neuroradiol J 2012; 25:360-3. [DOI: 10.1177/197140091202500312] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 05/18/2012] [Indexed: 11/16/2022] Open
Abstract
The development of the pituitary gland is not well understood, but duplication of the gland, a rare embryonic anomaly, may shed some light on the process. Since 1880 only about 40 cases have been described. A 56-year-old woman complained of chronic bilateral upper extremity paresthesia and numbness along her first three fingers relieved by rest and exacerbated by increased activity. Magnetic resonance imaging of her head and neck showed an incidental discovery of a duplication of the pituitary infundibulum and pituitary fossa. Computed tomography of the neck showed congenital fusion of C2 with C3, C4 with C5, C1 with the occipital bone, and a duplication of the odontoid process. Her physical examination and all laboratory data were negative. Only seven patients with a pituitary duplication have ever survived beyond puberty. While all of these patients had normal mental capabilities, they also all had obvious craniofacial malformations. Unlike our patient, all other reported cases of duplicated pituitaries have been associated with abnormalities of the face or brain. Previously proposed theories for duplicated pituitary glands include failed twinning, teratogens, and an extreme form of the median cleft face syndrome. We feel that the cleft theory developed by Morton et al. best describes the cause of our patient's malformations. Such anomalous presentations will improve our understanding of how the pituitary gland develops and the order in which cranial structures develop to cause these cranial malformations.
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Affiliation(s)
- Y. Usta
- Division of Internal Medicine, St Joseph's Hospital and Medical Center; Phoenix, AZ, USA
| | - F. Sakha
- Division of Internal Medicine, St Joseph's Hospital and Medical Center; Phoenix, AZ, USA
| | - W.L. White
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center; Phoenix, AZ, USA
| | - A.S. Little
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center; Phoenix, AZ, USA
| | - L. Knecht
- Division of Endocrinology, St Joseph's Hospital and Medical Center; Phoenix, AZ, USA
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24
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Elliott RE, Tanweer O, Rubin BA, Koslow M, Mikolaenko I, Wisoff JH. Suprasellar hamartoma and arachnoid cyst. World Neurosurg 2012; 80:e401-7. [PMID: 22381854 DOI: 10.1016/j.wneu.2012.01.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 01/31/2012] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The differential diagnosis for suprasellar masses includes a variety of pathologies, ranging from stable and benign lesions to aggressive and malignant ones. We report a case of a suprasellar hamartoma associated with an arachnoid cyst and review the literature surrounding the topic. CASE DESCRIPTION A 32-year-old man who presented with headaches and nonspecific vision loss was found to have a cystic, calcified, and minimally contrast enhancing lesion of the suprasellar region. Intraoperative inspection revealed a discrete mass in the right side of suprasellar region that resembled normal brain completely enveloped by the basal arachnoid membranes including the membrane of Lillequist and was not connected to the brain. Fenestration and exploration of the cystic portion demonstrated a simple arachnoid cyst filled with what appeared to be cerebrospinal fluid. Given the adherence of the lesion to numerous perforating arteries arising from the posterior communicating artery, a biopsy with intraoperative confirmation was taken. Pathology was consistent with neuroglial tissue without evidence of neoplasia. CONCLUSIONS To our knowledge this is only the third case of an isolated suprasellar hamartoma described in the literature and the first of its kind to be associated with an arachnoid cyst.
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25
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Manjila S, Miller EA, Vadera S, Goel RK, Khan FR, Crowe C, Geertman RT. Duplication of the pituitary gland associated with multiple blastogenesis defects: Duplication of the pituitary gland (DPG)-plus syndrome. Case report and review of literature. Surg Neurol Int 2012; 3:23. [PMID: 22439114 PMCID: PMC3307243 DOI: 10.4103/2152-7806.92939] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 12/19/2011] [Indexed: 11/07/2022] Open
Abstract
Background: Duplication of the pituitary gland (DPG) is a rare craniofacial developmental anomaly occurring during blastogenesis with postulated etiology such as incomplete twinning, teratogens, median cleft face syndrome or splitting of the notochord. The complex craniocaudal spectrum of blastogenesis defects associated with DPG is examined with an illustrative case. Case Description: We report for the first time in the medical literature some unique associations with DPG, such as a clival encephalocele, third cerebral peduncle, duplicate odontoid process and a double tongue with independent volitional control. This patient also has the previously reported common associations such as duplicated sella, cleft palate, hypertelorism, callosal agenesis, hypothalamic enlargement, nasopharyngeal teratoma, fenestrated basilar artery and supernumerary teeth. This study also reviews 37 cases of DPG identified through MEDLINE literature search from 1880 to 2011. It provides a detailed analysis of the current case through physical examination and imaging. Conclusion: The authors propose that the developmental deformities associated with duplication of pituitary gland (DPG) occur as part of a developmental continuum, not as chance associations. Considering the fact that DPG is uniquely and certainly present throughout the spectrum of these blastogenesis defects, we suggest the term DPG-plus syndrome.
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Affiliation(s)
- Sunil Manjila
- Division of Neurosurgery, MetroHealth Medical Center, Cleveland, Ohio
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26
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Abstract
Pituitary gland duplication is a rare malformation of unknown cause that is often associated with a nasopharyngeal teratoma, among other secondary malformations. This clinical report describes a case of pituitary gland duplication with a nasopharyngeal teratoma, cleft palate, and hypothalamic hamartoma, as well as the surgical management of this patient. This case also raises the question of whether the nasopharyngeal teratoma is the cause of the pituitary duplication above and the cleft palate below or whether it is a result of the primary duplication of the notochordal process. Various theories are presented in an attempt to answer this question, but the exact cause of these malformations remains equivocal. Future research in this topic may elucidate the answer to this question.
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Pituitary duplication: a rare cause of precocious puberty. Childs Nerv Syst 2011; 27:1157-60. [PMID: 21484457 DOI: 10.1007/s00381-011-1443-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 03/23/2011] [Indexed: 10/18/2022]
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28
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Petridis AK, Barth H. Pituitary stalk duplication in ventral-dorsal direction in a patient with pituitary gland adenoma and aqueductal stenosis. Clin Anat 2010; 23:879-80. [PMID: 20830795 DOI: 10.1002/ca.21030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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29
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Madhusudhan KS, Kandpal H. Pituitary stalk duplication with intrasellar dermoid and herniation of the third ventricle. Pediatr Radiol 2009; 39:1013. [PMID: 19277632 DOI: 10.1007/s00247-009-1198-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 01/29/2009] [Accepted: 02/03/2009] [Indexed: 11/26/2022]
Affiliation(s)
- Kumble S Madhusudhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
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30
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Manara R, Citton V, Rossetto M, Padoan A, D'Avella D. Hypophyseal triplication: case report and embryologic considerations. AJNR Am J Neuroradiol 2009; 30:1328-9. [PMID: 19299490 DOI: 10.3174/ajnr.a1520] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY Hypophyseal triplication is malformation that has not been described previously. We present a child with midline abnormalities who underwent epignathus excision at birth. Brain MR imaging revealed 2 paired lateral pituitary glands and an oval midline gland, each with an independent stalk, connected to a thickened third ventricle floor. Because malformations represent a failure in embryogenesis, this case may provide interesting clues on the normal development of the hypophysis.
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Affiliation(s)
- R Manara
- Neuroradiologic Unit, University Hospital of Padua, Padua, Italy.
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31
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Fetal central nervous system malformations on MR images. Brain Dev 2009; 31:185-99. [PMID: 18762395 DOI: 10.1016/j.braindev.2008.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 07/18/2008] [Accepted: 07/22/2008] [Indexed: 11/22/2022]
Abstract
Sonography is the method of choice for prenatal malformation screening but it does not always provide sufficient information for correct diagnosis or adequate abnormality evaluation. Fetal magnetic resonance imaging (MRI) is considered as a valuable second line imaging tool for confirmation, completion and correction of sonographic findings. Fetal MRI has proven its value in the evaluation of central nervous system pathologies, especially of midline and posterior fossa malformations. The role of MRI is not only to confirm or exclude possible lesions but also to define their full extent, aiding in their characterization, and to demonstrate associated abnormalities. The authors describe the most common anomalies of CNS revealed by fetal MRI in a chronological way related to the age of pregnancy, with a review of own MR images and with reference to the literature and own experience.
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32
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Pituitary stalk duplication in association with moya moya disease and bilateral morning glory disc anomaly - broadening the clinical spectrum of midline defects. J Neurol 2008; 255:885-90. [PMID: 18350354 DOI: 10.1007/s00415-008-0799-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Revised: 09/24/2007] [Accepted: 10/29/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Duplication of the pituitary stalk, morning glory disc anomaly and moya moya are rare malformations. The combination of these findings may be syndromic and may have an underlying genetic etiology. METHODS Case report and review of the literature of neurological, ophthalmological, and neuroradiological findings including ophthalmic examination, MRI and MRA. CASE REPORT A 2 year-old girl presented with reduced visual acuity and roving eye movements since birth. Ophthalmological workup revealed bilateral morning glory disc anomaly. MRI showed duplication of the pituitary stalk and caudal displacement of the floor of the third ventricle. MRA showed narrowing of the supraclinoid internal carotid arteries with focal narrowing of the proximal middle cerebral arteries consistent with early moya moya disease. CONCLUSIONS Review of the literature of pituitary gland duplication and of the combination of morning glory disc anomaly and moya moya disease revealed only one previously reported case. However, the spectrum of this possibly syndromic presentation may be much broader and include various types of anterior midline defects and may have a common underlying genetic cause.
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33
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Kandpal H, Seith A, Philip J, Gupta R, Ammini AC. Partial Duplication of the Hypophysis in Adult Patients. J Comput Assist Tomogr 2007; 31:365-7. [PMID: 17538280 DOI: 10.1097/01.rct.0000243458.08061.f1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Complete duplication of the pituitary gland is an extremely rare condition which is associated with a wide range of anomalies. An incomplete duplication affecting only the anterior pituitary gland or the pituitary stalk has not been described so far. We report 2 such cases of partial duplication of the hypophysis and briefly review the literature.
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Affiliation(s)
- Harsh Kandpal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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34
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Davis SW, Camper SA. Noggin regulates Bmp4 activity during pituitary induction. Dev Biol 2007; 305:145-60. [PMID: 17359964 PMCID: PMC1913218 DOI: 10.1016/j.ydbio.2007.02.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Revised: 01/31/2007] [Accepted: 02/01/2007] [Indexed: 11/23/2022]
Abstract
Bone morphogenetic protein (Bmp) signaling is critical for the development and patterning of the mouse pituitary from the initial induction of Rathke's pouch to cell specification in the anterior lobe. We examined the regulation of Bmp signaling during pituitary development by analyzing null embryos for noggin, a Bmp 2 and 4 antagonist. Noggin is expressed in the ventral diencephalon during Rathke's pouch induction, in the underlying cartilage plate during cell specification and in the adult anterior pituitary gland. Noggin null embryos have a variable pituitary phenotype, which ranges from a rostrally displaced Rathke's pouch to induction of secondary pituitary tissue. While cell specification in the anterior pituitary appears normal, patterning in the ventral diencephalon is disrupted; Bmp4 activity is expanded resulting in Fibroblast growth factor 10 repression and in a rostral shift in the boundary between the Bmp4 and Sonic hedgehog expression domains. The expanded domain of Bmp4 activity also results in additional invaginations of oral ectoderm and can shift the position of Rathke's pouch or create secondary pituitary tissue. This work demonstrates the importance of attenuating the activity of Bmp signaling during pituitary induction in order to maintain the proper balance of signaling factors necessary for pituitary organogenesis.
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Affiliation(s)
- Shannon W. Davis
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI 48109-0618
| | - Sally A. Camper
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI 48109-0618
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35
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Garel C, Léger J. Contribution of magnetic resonance imaging in non-tumoral hypopituitarism in children. HORMONE RESEARCH 2006; 67:194-202. [PMID: 17159354 DOI: 10.1159/000097755] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Accepted: 11/02/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is of paramount importance for evaluating the hypothalamo-pituitary axis in children. METHODS We summarize the main points of the MRI technique, and describe the normal appearance of the hypothalamo-pituitary axis as a function of age and pubertal status. The most frequent causes of non-tumoral hypopituitarism include anterior pituitary deficiency (growth hormone deficiency may be isolated or associated with other anterior pituitary hormone deficiencies, with or without other malformations, and related to a known genetic abnormality in some cases), isolated hypogonadotropic hypogonadism and posterior pituitary deficiency with or without anterior pituitary hormone deficiency (central diabetes insipidus may be observed without tumor development). RESULTS We describe in detail the appearance of the adenohypophysis, the pituitary stalk and the neurohypophysis, correlations with hormone deficiencies, the abnormalities that may be associated and progression over time for each condition. CONCLUSION An accurate description of hypothalamo-pituitary axis abnormalities is necessary for accurate diagnosis and prognosis evaluation, with certain features suggestive of particular diseases and some prognostic data correlated with phenotype.
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Affiliation(s)
- Catherine Garel
- Department of Pediatric Imaging, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris VII University, Paris, France.
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36
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Abstract
The adenohypophysis and neurohypophysis originate from the combination of 2 events occurring during the fourth week of life, the development of Rathke pouch and of a neuroectodermal evagination of tissue from the floor of the diencephalon. Congenital pathology of the pituitary gland and parasellar regions derives from abnormalities of these coordinated events. In this article, we review the pathogenesis, clinical presentation, and imaging features of common and rare congenital disorders of the region of the sella turcica.
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Affiliation(s)
- M Vittoria Spampinato
- Department of Radiology, Medical University of South Carolina, Charleston, SC 29425, USA.
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38
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Huisman TAGM, Fischer U, Boltshauser E, Straube T, Gysin C. Pituitary duplication and nasopharyngeal teratoma in a newborn: CT, MRI, US and correlative histopathological findings. Neuroradiology 2005; 47:558-61. [PMID: 15942796 DOI: 10.1007/s00234-005-1374-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2004] [Accepted: 01/10/2005] [Indexed: 11/25/2022]
Abstract
The computed tomography and MRI imaging findings in a case of pituitary duplication and epipharyngeal teratoma are described in a newborn baby girl with respiratory difficulties. Associated skull base and central nervous system malformations are presented. Teratoma diagnosis was confirmed by histology. The embryological pathogenesis is discussed.
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Affiliation(s)
- Thierry A G M Huisman
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Switzerland.
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39
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Slavotinek A, Parisi M, Heike C, Hing A, Huang E. Craniofacial defects of blastogenesis: duplication of pituitary with cleft palate and orophgaryngeal tumors. Am J Med Genet A 2005; 135:13-20. [PMID: 15810008 DOI: 10.1002/ajmg.a.30694] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Duplications of organs and/or tissues are rare in morphogenesis and have frequently been attributed to incomplete twinning. To further elucidate the phenotypes associated with organ duplications, we present three infants with duplication of the pituitary gland (DPG). A review of previously reported cases with DPG showed that the commonest additional findings were hypothalamic enlargement, a broad or duplicated sella, cleft palate, hypertelorism, oropharyngeal tumors, agenesis or hypoplasia of the corpus callosum, and abnormalities of vertebrae. DPG and additional malformations constitute a distinct and recognizable pattern of anomalies, which may constitute a polytopic field defect due to splitting of the notochord. However, the precise inductive mechanism resulting in DPG remains unknown.
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Affiliation(s)
- Anne Slavotinek
- Department of Pediatrics, Division of Genetics, University of California-San Francisco, 553 Parnassus Street, Rm. U-585P, San Francisco, CA 94143, USA.
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de Penna GC, Pimenta MP, Drummond JB, Sarquis M, Martins JCT, de Campos RC, Dias EP. Duplication of the hypophysis associated with precocious puberty: presentation of two cases and review of pituitary embryogenesis. ACTA ACUST UNITED AC 2005; 49:323-7. [PMID: 16184265 DOI: 10.1590/s0004-27302005000200023] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pituitary duplication is a rare malformation commonly associated with other major neural/craniofacial anomalies, easily shown by magnetic resonance imaging. The authors describe two girls with duplication of the pituitary gland and thickening of the hypothalamus, facial dysmorphism and precocious pubertal development. The pathogenesis of pituitary duplication and its relationship with precocious pubertal development are discussed.
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Affiliation(s)
- Christopher P Vittore
- Department of Radiology, University of Illinois College of Medicine, Rockford Memorial Hospital, 2400 N Rockton Ave, Rockford, IL 61103, USA
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Mutlu H, Paker B, Gunes N, Emektar A, Keceli M, Kantarci M. Pituitary duplication associated with oral dermoid and corpus callosum hypogenesis. Neuroradiology 2004; 46:1036-8. [PMID: 15565346 DOI: 10.1007/s00234-004-1296-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2004] [Accepted: 09/06/2004] [Indexed: 10/26/2022]
Abstract
We report a case of pituitary duplication in a neonate girl whose magnetic resonance (MR) images showed unusual findings of hypogenesis of the corpus callosum and oral dermoid. Pituitary duplication is an extremely rare malformation, with only a few previously reported cases. It occurs most commonly in association with complicated midline and skull base anomalies. We present a case of this malformation with special emphasis on the hypogenesis of splenium of the corpus callosum and oral dermoid.
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Affiliation(s)
- Hakan Mutlu
- Radyoloji Servisi, GATA Haydarpasa Egt. Hst., 81327, Uskudar, Istanbul, Turkey.
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Keller RL, Hamrick SEG, Kitterman JA, Fineman JR, Hawgood S. Treatment of rebound and chronic pulmonary hypertension with oral sildenafil in an infant with congenital diaphragmatic hernia. Pediatr Crit Care Med 2004; 5:184-7. [PMID: 14987351 DOI: 10.1097/01.pcc.0000113266.26638.ad] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We describe a case of chronic pulmonary hypertension in a 7-wk-old infant with congenital diaphragmatic hernia and an oral teratoma. Our patient was dependent on low-dose inhaled nitric oxide and was still very unstable with systemic right ventricular pressures leading to frequent oxygen desaturations. We administered sildenafil therapy to stabilize the infant with discontinuation of inhaled nitric oxide. We describe successful discontinuation of the inhaled therapy as well as a period of stabilization and improvement with continued sildenafil administration. DESIGN Case report. SETTING Intensive care nursery in tertiary academic center. PATIENT A 7-wk-old infant with congenital diaphragmatic hernia who was mechanically ventilated from birth. INTERVENTION Oral sildenafil 0.3 mg/kg/dose every 12 hrs. MEASUREMENTS AND RESULTS Right ventricular pressure (from tricuspid valve regurgitant flow) to systemic systolic arterial pressure was measured by echocardiogram. Right ventricular to systemic pressure ratio was marginally improved with the initiation of sildenafil therapy. Inhaled nitric oxide was successfully discontinued, and the patient clinically stabilized temporarily, but he ultimately succumbed to his pulmonary hypertension. CONCLUSION Sildenafil may be a useful therapy for chronic pulmonary hypertension in congenital diaphragmatic hernia, but further studies of safety and efficacy need to be performed.
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Affiliation(s)
- Roberta L Keller
- Cardiovascular Research Institute and the Department of Pediatrics, The University of California San Francisco, San Francisco, CA, USA
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Leite CDC, Lacerda MTCD, Costa MORD, Amaro Júnior E, Sato A, Passos VQ, Pereira MAA, Carvalho LRSD. Duplicação da hipófise e da haste hipofisária: relato de um caso e revisão da literatura. Radiol Bras 2001. [DOI: 10.1590/s0100-39842001000300011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Os autores relatam um caso de uma paciente do sexo feminino, com idade cronológica de sete anos, idade óssea de 11 anos, aparecimento de mamas Tanner III bilateralmente, cuja investigação diagnóstica confirmou quadro de puberdade precoce dependente de gonadotrofinas, e a ressonância magnética da hipófise evidenciou duplicação da haste e da glândula hipofisária associada a hamartoma hipotalâmico.
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Affiliation(s)
- W W Lam
- Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, Shatin, Hong Kong
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Hori A, Schmidt D, Kuebber S. Immunohistochemical survey of migration of human anterior pituitary cells in developmental, pathological, and clinical aspects: a review. Microsc Res Tech 1999; 46:59-68. [PMID: 10402273 DOI: 10.1002/(sici)1097-0029(19990701)46:1<59::aid-jemt6>3.0.co;2-s] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Developmentally pathological conditions of the anterior pituitary cells include failed separation of the primary pituitary gland into sellar and pharyngeal ones, ectopic migration into the subarachnoid space, and basophil invasion into the posterior lobe although the last is a physiological phenomenon with pathological potentiality in certain circumstances. Pituitary primordium appears at about 4 weeks of gestation. One of the causes of the pituitary gland agenesis may be a formation of the primary hypothalamic ganglionic hamartoma just at the time of occurrence of the pituitary primordium, as analyzed in cases of Pallister-Hall syndrome. A double pituitary in a single individual is a rare malformation. Its pathogenesis is considered as a result of notochordal anomaly. In the 8th gestational week, the primary pituitary gland separates into sellar and pharyngeal parts. The disturbance of this histogenesis results in a rare pituitary malformation, a "pharyngosellar pituitary." Despite the failed separation in this case, differentiation of the pituitary cells proceeds and the hormone production of this malformed pituitary gland can be displayed immunohistochemically. In this case, the distribution of the different hormone producing cells was atypical, particularly in those of gonadotropic hormones and ACTH. Life-long existence of the pharyngeal pituitary is a normal anatomical state in humans. Cell differentiation (hormone production) in the pharyngeal pituitary occurs about 4-10 weeks later than in the sellar pituitary. In pharyngeal pituitary, all kinds of adenohypophyseal hormones are produced. Extracranial pituitary adenomas (with intact sellar pituitary), exclusively found in the nasopharynx, sphenoid sinus, and clivus, may occur from the pharyngeal pituitary while another tumorigenesis can develop from the residual tissue fragment in the craniopharyngeal canal. The "overshoot" of the adenohypophyseal cell migration in the distal part of the sellar pituitary is frequently observed in the leptomeninges of the peri-infundibular or peri-hypothalamic region as ectopic pituitary cell clusters that are apparently independent of the pars tuberalis. It is suggested that these cells, frequently found in "normal" individuals, may be one of the possible origins of the intracranial ectopic pituitary adenomas. However, the reason why a majority of the reported intracranial ectopic pituitary tumors are ACTH-adenomas remains unexplained, since the ectopic cells, found in "normal" individuals, consist of fairly different hormone-producing cells. A further enigmatic phenomenon is a "basophil invasion." ACTH-positive cells invade from the pars intermedia into the posterior lobe of the pituitary. This invasion increases in intensity and frequency according to increase in age. However, the invasion of ACTH cells is observed as early as in the fetal life. The invasive cells display occasionally cell atypia as well as mitotic activity. The origin of extremely rare pituitary adenomas inside the posterior lobe can be explained by the existence and proliferative activity of basophil invasion.
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Affiliation(s)
- A Hori
- Institute of Neuropathology, Med. Hochschule Hannover, Hannover, Germany.
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Arifa N, Léger J, Garel C, Czernichow P, Hassan M. [Cerebral anomalies associated with growth hormone insufficiency in children: major markers for diagnosis?]. Arch Pediatr 1999; 6:14-21. [PMID: 9974090 DOI: 10.1016/s0929-693x(99)80067-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PATIENTS AND METHODS The role of cerebral magnetic resonance imaging (MRI) in the diagnosis of growth hormone (GH) deficiency in children has been studied in 100 children. The diagnosis of GH deficiency was assessed at a mean age of 6.7 +/- 4.1 years: morphological abnormalities of the hypothalamic-pituitary (HP) region have been studied in three different groups: in the first group (70 cases), the neurohypophysis was present and normally located; in the second group (ten cases) it was missing; in the third group (20 cases) the neurohypophysis was ectopic (truncated stalk syndrome with ectopic neurohypophysis, small antehypophysis, thin or non-visualized stalk). RESULTS In the majority of cases, children presenting with only one morphological abnormality of the HP region (ectopic neurohypophysis or small antehypophysis or non-visualized or thin stalk) had an isolated GH deficiency. When multiple morphological abnormalities were present, anterior pituitary deficiency was multiple in more than half the cases. Cerebral midline anomalies (above all Chiari I malformation and basipharyngeal canal) had been observed in 20% of the children presenting with GH deficiency. In the majority of cases (95%), these anomalies were associated with one or more abnormalities of the HP region. A familial case is reported: morphological anomalies of the HP region were different for both siblings. Genetic factors are evoked. CONCLUSION The severity of the hormone deficiency is correlated to the ectopic location of the neurohypophysis, the thin appearance or non visibility of the pituitary stalk and the associated midline anomalies.
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Affiliation(s)
- N Arifa
- Département d'imagerie pédiatrique, hôpital Robert-Debré, Paris, France
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FitzPatrick M, Tartaglino LM, Hollander MD, Zimmerman RA, Flanders AE. Imaging of sellar and parasellar pathology. Radiol Clin North Am 1999; 37:101-21, x. [PMID: 10026732 DOI: 10.1016/s0033-8389(05)70081-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article reviews the complex anatomic relationships between structures in the sellar and parasellar regions. Normal anatomy and the normal imaging spectrum are reviewed, with emphasis on the diversity of pathology that originates from this region. Both CT and MR imaging may be used to evaluate the sellar and parasellar regions. This article discusses how modern imaging techniques enable characterization of the many lesions that alter the structure and function of normal sellar and parasellar anatomy.
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Affiliation(s)
- M FitzPatrick
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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