The Thickening of the Pituitary Stalk: about 25 Cases

Abstract

Summary This is a retrospective study of 25cases of thickening of pituitary stalk. All patients benefited from a clinical, biological (hormonal and non hormonal) and radiological exploration seeking etiology and scalability of their pathologies. Results A female predominance was found. The average is 42 years (4.5 to 60). Three children were observed in this series. Methods The most frequent reason for consultation was polyuria polydipsia syndrome (90%); It was associated with an amenorrhea galactorrhea syndrome in a little over two-thirds (63.2%) and epilepsy in one case. Questioning revealed the former existence of extra-pituitary sarcoidosis in five cases. The hormonal exploration showed a post pituitary insufficiency in all cases; A central diabetes insipidus (CDI) is observed in three pediatric cases. It was associated with hypopituitarism in 87,5% (n: 21/24) of cases: anterior pituitary Insufficiency (n: 10/24) thyreo-gonadotrope insufficiency (n: 11/24). Moderate hyperprolactinemia was observed in two thirds of cases (68, 4%). CDI is observed in three pediatric cases. The etiological exploration of the thickening of the pituitary stalk allowed to retain the following diagnoses: sarcoidosis 66,6% (n: 16/24)-lymphocytic hypophysitis 12,5% (n: 3/24 ) metastase cancer 12,5% (n: 3/24): vesicular thyroid carcinoma n: 1, breast cancer n: 2; cyst ratke 4.16% ( n: 1/24) « idiopathic » 8.3% (n: 2/24). The cyst of ratkes and idiopathic forms were found in children. The evolution was marked in a child by the appearance of an autoimmune thyroiditis suggest the possible diagnosis of an autoimmune origin to the thickening of the pituitary stalk. No cause has been identified in the other case after a decline of ten years.