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Endocr Pract. 2019 Mar 13. doi: 10.4158/EP-2018-0550. [Epub ahead of print]

PITUITARY STALK THICKENING IN A LARGE COHORT - TOWARDS MORE ACCURATE PREDICATORS OF PITUITARY DYSFUNCTION AND ETIOLOGY.

Author information

1
From: 1Department of Endocrine and Metabolic Diseases, Rui-jin Hospital, Shanghai Jiao-tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai, China. 200025.
2
Department of Pathology, Rui-jin Hospital, Shanghai Jiao-tong University School of Medicine, Shanghai, China. 200025.
3
Department of Neurosurgery, Rui-jin Hospital, Shanghai Jiao-tong University School of Medicine, Shanghai, China. 200025.
4
Department of Radiology, Rui-jin Hospital, Shanghai Jiao-tong University School of Medicine, Shanghai, China. 200025.

Abstract

OBJECTIVE:

To summarize the characteristics of patients with pituitary stalk thickening, analyze the association between pituitary stalk width and hypopituitarism, and develop a diagnostic model to differentiate neoplastic and inflammatory origins.

METHODS:

325 patients with pituitary stalk thickening in a tertiary teaching hospital between January 2012 and February 2018 were enrolled. Basic characteristics and hormonal status were evaluated. Indicators to predict etiology in patients with histological diagnoses were analyzed.

RESULTS:

Of the 325 patients, 62.5% were females. Deficiencies in gonadotropin was most common, followed by corticotrophin, growth hormone and thyrotropin. The increase of pituitary stalk width was associated with a risk of central diabetes insipidus (OR=3.57, P<0.001) and with a combination of central diabetes insipidus and anterior pituitary deficiency (OR=2.28, P=0.029). The cut-off pituitary stalk width of 4.75 mm had a sensitivity of 69.2% and a specificity of 71.4% for the presence of central diabetes insipidus together with anterior pituitary deficiency. Six indicators (central diabetes insipidus, patterns of pituitary stalk thickening, pituitary stalk width, neutrophilic granulocyte percentage, serum sodium level and gender were used to develop a model having an accuracy of 95.7% to differentiate neoplastic from inflammatory causes.

CONCLUSIONS:

Pituitary stalk width could indicate the presence of anterior pituitary dysfunction especially in central diabetes insipidus patients. With the use of a diagnostic model, the neoplastic and inflammatory causes of pituitary stalk thickening could be preliminarily differentiated.

PMID:
30865546
DOI:
10.4158/EP-2018-0550

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