Endocrine Abstracts

The increasing availability of MR imaging has led to a rise in the number of referrals of children with pituitary abnormalities to endocrinologists. We are presenting the cases of two female teenagers who underwent pituitary MRI in the context of an intensive headache without associating symptoms suggestive of pituitary insufficiency.

Case 1: 12.5 yo girl admitted in neurology clinic due to an episode of lipotimia associated with intense headache; the MRI showed enlargement of the anterior pituitary and a stalk of 6.5 mm; a trial of glucocorticoid before an extensive hormonal workup (normal prolactin and thyroid function tests). Her visual field assessment was normal, and she had normal urinary output. 2 weeks after the glucocorticoid was started, the stalk decreased to 3.6 mm and continued to improve with normal MRI appearance 1.5 years after the first description of global; her headache decreased gradually; a full pituitary workup showed a normal range for pituitary hormones. Tumor markers were negative, as well as markers for hypophysitis.

Case 2: A 15-year-old girl had a pituitary MRI due to intense headaches that showed an enlarged pituitary with a craniocaudal diameter -16 mm abutting the optic chiasm and normal stalk. Her previous history is positive for autoimmune hepatitis under azathioprine since the age of 5 yo. Pituitary hormones and visual field were normal at the presentation and in the follow-up visit with spontaneous partial regression of the pituitary enlargement and evident distance until the optic chiasm.

Discussion: The diagnosis of hypophysitis has a big probability in both cases: first case because of the stalk enlargement and response to glucocorticoid; the second case because of her autoimmune history and spontaneous reversal of pituitary enlargement. This should be considered, due to the need for follow-up for the occurrence of isolated corticotrope insufficiency – following regression of inflammation.