Cerebral fluid sampling and
pituitary stalk biopsy were considered deferred.
Other causes of hyperprolactinemia were sorted into non-pituitary masses (n=6), craniopharyngioma (n=5), macroprolactinemia (n=5), hypothyroidism (n=3), polycystic ovary syndrome (n=2),
pituitary stalk interruption syndrome (PSIS) (n=2), rapid-onset obesity with hypothalamic dysfunction, hypoventilation, autonomic dysfunction syndrome (n=2) and tuberous sclerosis (n=1).
Other pituitary adenomas which not secrete prolactin may also cause hyperprolactinemia by compression of the
pituitary stalk. Likewise, conditions affecting the hypothalamus such as granulomatous disorders, gliomas, craniopharyngiomas, metastases, trauma, and cranial irradiation may also cause prolactin elevation.
Figure 1 shows spectacular skull base structures such as the pituitary gland,
pituitary stalk, branches of the circle of Willis, and the sellar region.
pituitary stalk thickening, pituitary enlargement, intense homogeneous post-contrast imbibition in adenohypophysis, and absence of high-intense signal in neurohypophysis on T1-weighted images (3).
1 case (26/f) MRI-enhancing suprasellar mass (9 x 6 mm), thickening of
pituitary stalk. Layden et al.
(4) In terms of imaging findings, the most characteristic feature of a pituitary metastasis is enlargement or enhancement of the
pituitary stalk with a pituitary mass.
Post operative reversible diabetes insipid us appears to be either due to the surgical trauma or fall of diaphragm sella as the adenoma is removed resulting in stretching of
pituitary stalk.6 Temporary DI was treated in 3 (16.6%) patients and they all improved.
None was found except for abnormal brain MRI findings showing a thickened
pituitary stalk and absent high signal at the posterior lobe of pituitary on T1WI (figure not shown).
We present the unique case of a 34-year-old man with
pituitary stalk inflammation, secondary to a germ cell tumor.
Pituitary stalk compression, a common side effect of pituitary metastases, may lead to elevated prolactin.
An MRI showed only an anterior pituitary hypoplasia, while those for patients with genetic GHD generally reveal a normal or hypoplastic pituitary gland without abnormalities of the hypothalamus, pituitary dystopia, agenesis of the pituitary gland, or thinning or interruption of the
pituitary stalk [17].
