Neuroendocrine Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotica 13, Belgrade, 11000, Serbia.
School of Medicine, University of Belgrade, Belgrade, Serbia.
Pituitary. 2018 Dec;21(6):605-614. doi: 10.1007/s11102-018-0914-2.
The etiological spectrum of pituitary stalk lesions (PSL) is wide and yet specific compared to the other diseases of the sellar and suprasellar region. Because of the pituitary stalk's (PS) critical location and role, biopsies of these lesions are rarely performed, and their underlying pathology is often a conundrum for clinicians. A pituitary MRI in association with a clinical context can facilitate their diagnosis.
To present the various causes of PSL-their clinical, hormonal, histopathological, and MRI characteristics in order to gain better insight into this pathology.
A retrospective observational study consisting of 53 consecutive patients with PSL of the mean age 32 ± 4.2 years (range 6-67), conducted at the Department for Neuroendocrinology, Clinical Center of Serbia 2010-2018.
Congenital malformations were the most common cause of PSL in 25 of 53 patients (47.1%), followed by inflammatory (9/53; 16.9%) and neoplastic lesions (9/53; 16.9%). The exact cause of PSL was established in 31 (58.4%) patients, of whom 23 were with congenital PS abnormalities and 8 with histopathology of PSL (7 neoplastic and 1 Langerhans Cell Hystiocytosis). A probable diagnosis of PSL was stated in 12 patients (22.6%): 6 with lymphocytic panhypophysitis, while Rathke cleft cyst, tuberculosis, dissemination of malignancy in PS were each diagnosed in 2 patients. In 10 patients (18.8%), the etiology of PSL remained unknown.
Due to the inability of establishing an exact diagnosis, the management and prognosis of PSL are difficult in many patients. By presenting a wide array of causes implicated in this condition, we believe that our study can aid clinicians in the challenging cases of this pathology.
与鞍区和鞍上区域的其他疾病相比，垂体柄病变（PSL）的病因谱较窄，但具有特异性。由于垂体柄（PS）的关键位置和作用，很少对这些病变进行活检，其潜在病理对临床医生来说常常是一个难题。垂体 MRI 结合临床情况有助于诊断这些病变。
介绍 PSL 的各种病因，包括其临床、激素、组织病理学和 MRI 特征，以便更好地了解这种病理。
这是一项回顾性观察研究，纳入了 2010 年至 2018 年在塞尔维亚临床中心神经内分泌科就诊的 53 例 PSL 连续患者，平均年龄 32±4.2 岁（范围 6-67 岁）。
先天性畸形是 53 例 PSL 患者中最常见的病因（25/53；47.1%），其次是炎症（9/53；16.9%）和肿瘤性病变（9/53；16.9%）。在 31 例（58.4%）患者中确定了 PSL 的确切病因，其中 23 例为先天性 PS 异常，8 例为 PSL 的组织病理学改变（7 例为肿瘤性，1 例为朗格汉斯细胞组织细胞增生症）。12 例（22.6%）患者被诊断为 PSL 的可能病因：6 例为淋巴细胞性全垂体炎，2 例分别诊断为 Rathke 裂囊肿、结核病、PS 恶性肿瘤转移，10 例（18.8%）患者 PSL 的病因仍未知。
由于无法明确诊断，许多 PSL 患者的治疗和预后都很困难。通过介绍该疾病涉及的广泛病因，我们相信我们的研究可以帮助临床医生处理该病理的挑战性病例。
