Endocrine Abstracts

Introduction: Pathologies of the pituitary stem are very often revealed during diabetes insipidus. The introduction of MRI constituted, in this context, a major diagnostic contribution. We report 4 cases of thickening of the pituitary stem observations. These are 4 patients (3 women and one man) whose age varies from 30 to 47 years, the circumstances of discovery are represented by amenorrhea in women and polyuropolydipsic syndrome in men. Clinically, diabetes insipidus was found in 3 patients, a gonadotropic deficit in 2 patients, a thyrotropic deficit in one case and panhypopituitarism in one case. The etiological investigation made it possible to retain the diagnosis of sarcoidosis in 2 cases and the diagnosis of Langerhansian histiocytosis in a patient, it was negative in one case.

Discussion: The pituitary stem connects the hypothalamus and the pituitary gland. It consists of two parts: at the top, the infundibulum, in direct contact with the tuber cinerum, at the hypothalamic level, at the bottom, the pituitary stem itself, which is extended by the posterior lobe of the pituitary gland. In case of pathology of the pituitary stem, the clinical picture is dominated by the occurrence of diabetes insipidus. It’s the most common mode of revelation. The thickening of the pituitary stem associated with diabetes insipidus can be observed in the event of tumor, granulomatous or inflammatory pathology. The etiological diagnosis of ‘large pituitary stems’ is sometimes very difficult. Tumor lesions should be considered first, especially in children or adolescents, as they condition the prognosis and treatment. In adults, inflammatory or granulomatous causes are more common. In the case of a large pituitary stem, completely isolated, simple monitoring, without histological evidence, can be offered (by renewing the MRI at 3–6 months). A very prolonged monitoring of the remote MRI is essential (annual monitoring), in the hypothesis of a histiocytosis with prolonged evolution or of a germinoma, in particular in the child and the adolescent.

Conclusion: The stem can be the target of various infiltrative, infectious and tumor pathologies. An exhaustive etiological investigation is essential to guide therapeutic managemen