Late-Onset Pituitary Stalk Interruption Syndrome

Abstract

A 21-year-old woman of low socio-economic status and no schooling consults for delayed puberty and primary amenorrhea. Her history includes a home delivery with no reported neonatal suffering. Examination revealed good general condition, normo-colored conjunctiva, statural delay at -3DS, absence of secondary sexual characteristics S1P1 of Tanner staging. Assessment of pituitary hormones showed collapsed GH and gonadotropin (LH and FSH) levels. Other hormones, including TSH/FT4 and ACTH, were normal. In view of the low FSH and LH levels, pituitary MRI was performed and showed an interruption of the pituitary stem with hypoplastic antehypophysis was about 2mm and pituitary stalk was interrupted (Figure 1 and 2). The patient received hormone replacement therapy.