What is the role of imaging studies in the diagnosis of hypopituitarism (panhypopituitarism)?

Updated: Jun 09, 2020
  • Author: Bernard Corenblum, MD, FRCPC; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

A study by Li et al concluded that magnetic resonance imaging (MRI) findings can be correlated with pituitary function and can provide evidence of multiple pituitary hormone deficiencies. The study included 96 pituitary hormone ̶ deficient children and 90 controls. The authors used MRI findings from the hypothalamic-pituitary region to divide the hormone-deficient patients into 5 stages. Based on serum concentrations of ACTH, cortisol, GH, insulinlike growth factor-1 (IGF-1), free T4, TSH, FSH, LH, testosterone, estradiol, and prolactin in the patients and controls, a positive correlation was found between the MRI-based stages and the number of pituitary hormone deficiencies in patients. [19, 20]  However, MRI does not eliminate the need for appropriate biochemical testing.

In the presence of clinical or biochemical evidence of hypopituitarism, visualization of the sella/suprasella areas is needed to identify the nature of the causative disease process. This is best performed through computed tomography (CT) scanning or MRI. The presence of a mass with hormonal hypersecretion indicates that it is likely a secretory pituitary adenoma. In the absence of hypersecretion, any mass/infiltrate may be of unknown etiology, but certain characteristics on CT scanning/MRI may suggest the pathologic cause in some cases. The presence of a lesion requires correlation with the clinical/biochemical data, and the absence of any visible lesion suggests a nonorganic cause in most cases.


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