Abstract
Pituitary stalk lesions (PSL) are a very rare pathology. The majority of conditions affecting the infundibulum do not present with clinically apparent symptoms, what makes the diagnosis difficult. The recognition might be also complicated by the non-specific and transient characteristics of hormonal insufficiencies. In our study, we retrospectively analysed demographic, biochemical, and clinical long-term data of 60 consecutive, unselected adult patients (34 women and 26 men) with PSL diagnosed in the Department of Endocrinology, Jagiellonian University in Krakow. The diagnosis of PSL were categorized as confirmed, probable, or undetermined in 26, 26 and 8 patients, accordingly. Given the possible aetiology congenital, inflammatory, and neoplastic stalk lesions were diagnosed in 17, 15 and 20 patients, accordingly. In eight cases the underlying pathology remained undetermined. The most common pituitary abnormality was gonadal insufficiency diagnosed in 50.8% of cases. Diabetes insipidus was detected in 23.3% of cases. In 5% of patients the pituitary function recovered partially over time. Stalk lesions were extensively discussed in the context of the current literature. Based on the published data and our own experience a diagnostic algorithm has been proposed to help physicians with the management of patients with this challenging condition.
Highlights
The pituitary stalk, known as the infundibulum, connects the hypothalamic median eminence with the pituitary gland
Confirmed diagnosis was assigned to 14 patients with pituitary stalk interruption syndrome (PSIS) and two patients with septo-optic dysplasia (SOD)
Other cases categorised as confirmed diagnosis were patients operated due to pituitary stalk tumours: six pituitary adenomas, one pituitary carcinoma with extrapituitary metastasis, one craniopharyngioma, one germinoma, and one lesion that was post-surgically verified as lymphocytic hypophysitis
Summary
The pituitary stalk, known as the infundibulum, connects the hypothalamic median eminence with the pituitary gland. Comprising both blood vessels and nerves, it constitutes an important element in the proper functioning of hormonal regulation. The clinical course of patients with identical pituitary stalk lesions (PSL). The stalk may itself be involved or in addition to other structures by processes originating in the hypothalamus or pituitary gland. The exact incidence of PSL is difficult to estimate; the widespread availability of magnetic resonance imaging (MRI), which is the modality of choice for visualizing sellar and parasellar structures, has increased the detection rate of these pathologies. Due to the specific localisation of the infundibulum and potential risks of biopsy, establishing an accurate diagnosis of the underlying disease frequently remains challenging and requires a systematic approach
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