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NEUROIMAGE
Year : 2020  |  Volume : 68  |  Issue : 6  |  Page : 1504-1505

Pituitary Stalk Transection Syndrome with Isolated Growth Hormone Deficiency and Ectopic Posterior Pituitary


1 Department of Radiology, Yashoda Hospital, Malakpet, Hyderabad, Telangana, India
2 Department of Endocrinology, Yashoda Hospital, Malakpet, Hyderabad, Telangana, India
3 Department of Neurology, Yashoda Hospital, Malakpet, Hyderabad, Telangana, India

Date of Web Publication19-Dec-2020

Correspondence Address:
Dr. Sravan K Marupaka
Plot No 364, South End Park, Mansoorabad, L. B. Nagar, Hyderabad - 500 068, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.304108

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How to cite this article:
Marupaka SK, Danda VR, Thiru JA, Ramineni KK, Jakkani R. Pituitary Stalk Transection Syndrome with Isolated Growth Hormone Deficiency and Ectopic Posterior Pituitary. Neurol India 2020;68:1504-5

How to cite this URL:
Marupaka SK, Danda VR, Thiru JA, Ramineni KK, Jakkani R. Pituitary Stalk Transection Syndrome with Isolated Growth Hormone Deficiency and Ectopic Posterior Pituitary. Neurol India [serial online] 2020 [cited 2021 Jan 20];68:1504-5. Available from: https://www.neurologyindia.com/text.asp?2020/68/6/1504/304108




Fourteen-year-old boy with reasonably good nutritional status walked into the endocrinology outpatient for the evaluation of short stature. His height was 110 cm. He had mild facial hypoplasia with micropenis and a testicular volume of 4 ml with preservation of baby fat. He had seizures in the past but is not on antiepileptic medication for last 1 year. The routine biochemical evaluation was unremarkable. Hormonal evaluation revealed normal levels of free thyroxine and cortisol. Insulin-like growth factor 1 (IGF-1) was less than 25 ng/ml.

Clinical diagnosis of isolated growth hormone deficiency was considered.

MRI evaluation of pituitary hypothalamic axis ruled out pituitary tumors. Anterior pituitary was hypoplastic with T1 hyperintensity of posterior pituitary being in an ectopic location at median eminence. Pituitary stalk was barely perceptible [Figure 1].
Figure 1: Pituitary stalk transection syndrome. (a) T1 FS sagittal and (b) T2 FS sagittal images in the midline reveal ectopic position of posterior pituitary at the median eminence. The hypoplastic anterior pituitary gland is well appreciated on both images. (c) Midline sagittal image of nonfat suppressed 3D T1 sequence and zoomed-in view of the pituitary hypothalamic axis of the same image (d) reveal the hypoplastic but intact pituitary stalk to better effect

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MRI picture led to the diagnosis of pituitary stalk transection syndrome[1] as the cause of isolated growth hormone deficiency in this case.

Study by Kornreich et al. in 1998 revealed that hypoplastic adenohypophysis with thin stalk and an ectopic posterior pituitary hyperintensity is characteristic of isolated growth hormone deficiency. The study also showed that multiple pituitary hormone deficiency was characteristically associated with absent pituitary stalk and hypoplastic or absent adenohypophysis.[2]

Our case of isolated growth hormone deficiency with hypoplastic adenohypophysis, thin infundibulum and ectopic posterior pituitary is consistent with the classical description of pituitary stalk transection syndrome in the literature.[2]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Van der Linden ASA, Van Es HW. Pituitary stalk transection syndrome with ectopic posterior pituitary gland. Radiol 2007;243:594-7.  Back to cited text no. 1
    
2.
Kornreich L, Horev G, Lazar L. MR findings in growth hormone deficiency: Correlation with severity of hypopituitarism. AJNR Am J Neuroradiol 1998;19:1495-9.  Back to cited text no. 2
    


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