Abstract
The clinical significance of pituitary uptake on routine whole body 18F-fluorodeoxyglucose (FDG) positron emission tomography/computer tomography (PET/CT) is not completely characterized. We seek to assess the potential differential diagnosis/underlying etiology of pituitary FDG uptake incidentally identified on routine PET/CT scans. A total of 24,007 PET/CT whole body scans in recent 5 years were retrospectively reviewed. Patients with maximum standardized uptake value (SUVmax) > 4.1 in the pituitary glands were identified. Cases with a known history of pituitary disorders were excluded. Nineteen cases were identified with incidental pituitary FDG uptake which all had a final pathological diagnosis/clinical follow up. Among them, there were 9 primary pituitary tumors, with SUVmax ranging from 4.7 to 29.3 (13.6 ± 9.8); 3 metastatic malignancy with SUVmax ranging from 7.3 to 32.3 (16.0 ± 10.6); 3 Langerhans cell histiocytosis (LCH) with SUVmax ranging from 6.0 to 26.0 (15.0 ± 10.2); 1 pituitary lymphocytic hypophysitis with SUVmax of 4.7. Of note, 3 cases with SUVmax of 7.5,7.9 and 9.6 showed no relevant clinical symptoms with negative results on subsequent magnetic resonance (MR) and were counted as benign physiologic uptake. The most common differential diagnosis of incidental pituitary uptake on routine whole body PET/CT scans was primary pituitary tumors, followed by metastatic malignancy, Langerhans cell histiocytosis, and inflammatory lymphocytic hypophysitis. Of note, benign physiologic uptake without corresponding lesions could also occur in our population.
Highlights
The pituitary gland is an important endocrine organ that releases multiple hormones, including certain tissue-targeting growth hormones and prolactin as well as pituitary hormones such as thyroid-stimulating hormone, adrenocorticotropic hormone, follicle stimulating hormone, and luteinizing hormone
We retrospectively examined patients who received imaging with exhibited pituitary hypermetabolism to investigate the clinical significance of this incidental FDG uptake on positron emission tomographic/computed tomographic (PET/CT) scans
The pituitary gland is located in the sellaturcica at the base of skull, and it is covered by the dura mater
Summary
The pituitary gland is an important endocrine organ that releases multiple hormones, including certain tissue-targeting growth hormones and prolactin as well as pituitary hormones such as thyroid-stimulating hormone, adrenocorticotropic hormone, follicle stimulating hormone, and luteinizing hormone. Pituitary tumor is the most common disease that affects this gland, and it can be classified as either non-functional pituitary tumor or hormone-secreting tumor. In addition to pituitary lesions, other illnesses can compromise the pituitary. Pituitary gland can manifest a focal FDG uptake on 18F-fluorodeoxyglucose (FDG) positron emission tomographic/computed tomographic (PET/CT) imaging as an incidental finding. The clinical significance of this incidental uptake on PET/CT scans has not been completely characterized. We retrospectively examined patients who received imaging with exhibited pituitary hypermetabolism to investigate the clinical significance of this incidental FDG uptake on PET/CT scans
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