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Anatomic and Pathologic Spectrum of Pituitary Infundibulum Lesions

¹ Department of Radiology, University of Utah, Salt Lake City, UT.
² Present address: Department of Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239.

View larger version (17K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —General pathologic spectrum of pituitary infundibulum lesions.

View larger version (22K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —Pathologic spectrum of pediatric infundibular disease.

View larger version (37K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —Pathologic spectrum of adult infundibular disease. INH = infundibuloneurohypophysitis, RCC = Rathke cleft cyst, Whipple's = Whipple's disease.

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —Sagittal graphic of pituitary stalk anatomy: infundibulum is composed of infundibular stem (curved arrow), median eminence of hypothalamus, from which it arises, and pars tuberalis (straight arrow). (Reprinted with permission from Harnsberger H. Head and neck digital teaching file. Salt Lake City, UT: Amirsys, 2002 [16])

View larger version (167K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —17-year-old boy with growth hormone deficiency and anosmia. (Reprinted with permission from Harnsberger H. Head and neck digital teaching file. Salt Lake City, UT: Amirsys, 2002 [16]) Sagittal (A) and coronal (B) unenhanced T1-weighted images through sella reveal pituitary hypoplasia. Pituitary gland and sella turcica are small. Note ectopic neurohypophyseal T1 hyperintensity (open arrow). Infundibular stem is always abnormal; in this case, it is markedly attenuated (solid arrow). Stalk may be well seen only after gadolinium administration. Associated abnormalities are frequent, as in this patient in whom septum pellucidum is absent.

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —17-year-old boy with growth hormone deficiency and anosmia. (Reprinted with permission from Harnsberger H. Head and neck digital teaching file. Salt Lake City, UT: Amirsys, 2002 [16]) Sagittal (A) and coronal (B) unenhanced T1-weighted images through sella reveal pituitary hypoplasia. Pituitary gland and sella turcica are small. Note ectopic neurohypophyseal T1 hyperintensity (open arrow). Infundibular stem is always abnormal; in this case, it is markedly attenuated (solid arrow). Stalk may be well seen only after gadolinium administration. Associated abnormalities are frequent, as in this patient in whom septum pellucidum is absent.

View larger version (154K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6 —Sagittal T1-weighted contrast-enhanced image through sella is diagnostic of hypophyseal duplication in this 69-year-old asymptomatic man. Complete pituitary gland and stalk (arrows) are duplicated. (Reprinted with permission from Harnsberger H. Head and neck digital teaching file. Salt Lake City, UT: Amirsys, 2002 [16])

View larger version (154K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —Adult male with infundibuloneurohypophysitis (INH). (Reprinted with permission from Harnsberger H. Head and neck digital teaching file. Salt Lake City, UT: Amirsys, 2002 [16]) Coronal (A) and sagittal (B) contrast-enhanced T1-weighted images through sella reveal typical imaging findings of INH. Note masslike thickening of infundibulum (arrow).

View larger version (158K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —Adult male with infundibuloneurohypophysitis (INH). (Reprinted with permission from Harnsberger H. Head and neck digital teaching file. Salt Lake City, UT: Amirsys, 2002 [16]) Coronal (A) and sagittal (B) contrast-enhanced T1-weighted images through sella reveal typical imaging findings of INH. Note masslike thickening of infundibulum (arrow).

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —23-year-old postpartum woman with hypophysitis and atypical infundibuloneurohypophysitis involving pituitary gland and stalk. (Reprinted with permission from Harnsberger H. Head and neck digital teaching file. Salt Lake City, UT: Amirsys, 2002 [16]) Coronal (A) and sagittal (B) contrast-enhanced T1-weighted images through sella. Note masslike enlargement of entire pituitary gland and stalk. Neurohypophyseal involvement was supported by clinical presentation of diabetes insipidus. With this degree of involvement, imaging appearance is indistinguishable from macroadenoma; however, histopathologic evaluation confirmed diagnosis of hypophysitis.

View larger version (152K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —23-year-old postpartum woman with hypophysitis and atypical infundibuloneurohypophysitis involving pituitary gland and stalk. (Reprinted with permission from Harnsberger H. Head and neck digital teaching file. Salt Lake City, UT: Amirsys, 2002 [16]) Coronal (A) and sagittal (B) contrast-enhanced T1-weighted images through sella. Note masslike enlargement of entire pituitary gland and stalk. Neurohypophyseal involvement was supported by clinical presentation of diabetes insipidus. With this degree of involvement, imaging appearance is indistinguishable from macroadenoma; however, histopathologic evaluation confirmed diagnosis of hypophysitis.

View larger version (155K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A —36-year-old man with sarcoidosis. (Reprinted with permission from Harnsberger H. Head and neck digital teaching file. Salt Lake City, UT: Amirsys, 2002 [16]) Axial (A) and coronal (B) contrast-enhanced T1-weighted images through pituitary stalk (arrow).

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B —36-year-old man with sarcoidosis. (Reprinted with permission from Harnsberger H. Head and neck digital teaching file. Salt Lake City, UT: Amirsys, 2002 [16]) Axial (A) and coronal (B) contrast-enhanced T1-weighted images through pituitary stalk (arrow).

View larger version (156K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10A —42-year-old man with Whipple's disease. (Reprinted with permission from Harnsberger H. Head and neck digital teaching file. Salt Lake City, UT: Amirsys, 2002 [16]) Axial (A) and sagittal (B) contrast-enhanced T1-weighted images show isolated thickening and enhancement of median eminence and pituitary infundibulum (arrow), subsequently proven at histopathology to be Whipple's disease.

View larger version (187K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10B —42-year-old man with Whipple's disease. (Reprinted with permission from Harnsberger H. Head and neck digital teaching file. Salt Lake City, UT: Amirsys, 2002 [16]) Axial (A) and sagittal (B) contrast-enhanced T1-weighted images show isolated thickening and enhancement of median eminence and pituitary infundibulum (arrow), subsequently proven at histopathology to be Whipple's disease.

View larger version (176K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11A —14-year-old boy with Langerhans cell histiocytosis (LCH). (Reprinted with permission from Harnsberger H. Head and neck digital teaching file. Salt Lake City, UT: Amirsys, 2002 [16]) Sagittal (A) and coronal (B) contrast-enhanced T1-weighted images reveal focal infundibular thickening in LCH, which was most common pediatric cause of infundibular masslike thickening in this series (arrow). Posterior pituitary ectopia was seen in all patients.

View larger version (158K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11B —14-year-old boy with Langerhans cell histiocytosis (LCH). (Reprinted with permission from Harnsberger H. Head and neck digital teaching file. Salt Lake City, UT: Amirsys, 2002 [16]) Sagittal (A) and coronal (B) contrast-enhanced T1-weighted images reveal focal infundibular thickening in LCH, which was most common pediatric cause of infundibular masslike thickening in this series (arrow). Posterior pituitary ectopia was seen in all patients.

View larger version (178K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12 —Sagittal contrast-enhanced T1-weighted image in 40-year-old woman reveals masslike thickening of pituitary infundibulum in intracranial germinoma (straight arrow). Recognition of subtle secondary pineal mass (curved arrow) is highly suggestive of diagnosis. (Reprinted with permission from Harnsberger H. Head and neck digital teaching file. Salt Lake City, UT: Amirsys, 2002 [16])

View larger version (167K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13 —Axial contrast-enhanced T1-weighted image in 62-year-old man shows lymphoma of pituitary infundibulum (solid arrow). Although isolated stalk involvement may be seen, enhancing periventricular masses in this patient improved diagnostic specificity (open arrow). (Reprinted with permission from Harnsberger H. Head and neck digital teaching file. Salt Lake City, UT: Amirsys, 2002 [16])

View larger version (163K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14A —34-year-old woman with elevated prolactin. (Reprinted with permission from Harnsberger H. Head and neck digital teaching file. Salt Lake City, UT: Amirsys, 2002 [16]) Sagittal contrast-enhanced T1-weighted image of infundibular adenoma shows that, superiorly, mass (open arrow) is inseparable from pituitary infundibulum (solid arrow).

View larger version (156K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14B —34-year-old woman with elevated prolactin. (Reprinted with permission from Harnsberger H. Head and neck digital teaching file. Salt Lake City, UT: Amirsys, 2002 [16]) Coronal contrast-enhanced T1-weighted image shows prolactinoma (white arrow) arising from stalk (black arrow).

View larger version (165K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 15A —35-year-old man with pituicytoma. (Reprinted with permission from Harnsberger H. Head and neck digital teaching file. Salt Lake City, UT: Amirsys, 2002 [16]) Sagittal (A) and coronal (B) contrast-enhanced T1-weighted images show that pituitary infundibulum (arrows) is closely associated with mass.

View larger version (160K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 15B —35-year-old man with pituicytoma. (Reprinted with permission from Harnsberger H. Head and neck digital teaching file. Salt Lake City, UT: Amirsys, 2002 [16]) Sagittal (A) and coronal (B) contrast-enhanced T1-weighted images show that pituitary infundibulum (arrows) is closely associated with mass.

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