The anatomical variations of 112 hypophysis and diaphragma sellae in Korean adult cadavers and coronal CT were studied. 1) The hypophysis was classified 4 types based on superior view. 2) The superior surface of the hypophysis was concave(65.9%) in cadavers and flat(55.3%) in CT. 3) The neural lobe was placed on the center of the posterior surface of the anterior lobe(72.3%). 4) The hypophysis was compressed by the internal carotid artery in 9.6%. 5) The mean A-P length, width and height of the hypophysis were 10.4mm, 14.2mm and 4.8mm in cadavers, respectively. The mean width and height in CT were 13.2mm and 5.0mm, respectively. 6) The width of the hypophysis was significantly different between man and woman. 7) The diaphragma sellae was concave or flat. 8) The diaphragmatic line was average 13.9mm in man and 14.6mm in woman. 9) The diaphragmatic foraman was circular or oval and the A-P diameter was greater than transverse one. 10) Type IIb that diaphragma sellae and hypophysis were concave according to Busch(1951) was 40.4%. 11) The empty sella was found in 14.4%.
Adult* ; Cadaver* ; Carotid Artery, Internal ; Female ; Humans ; Pituitary Gland* ; Pituitary Gland, Posterior

We experienced one case of severe pituitary dwarfism in a 16 years old male boy that magnetic resonance image(MRI) revealed transection of the pituitary stalk with the ectopic location of posterior pituitary gland and hypoplastic anterior pituitary gland. The serum growth horrnone(GH) response to clonidine and L-dopa revealed severe GH deficiency. The patient revealed normal response in TSH, prolactin and LH, FSH to TRH and LHRH respectively. So far, the primary cause of idiopathic pituitary dwarfism in many patients was due to hypoxic injury to hypothalmus by perinatal insults. In this patients, there was no history of perinatal insults and postnatal head trauma. We report a case of severe dwarfism due to hypogenesis of anterior pituitary gland.
Clonidine ; Craniocerebral Trauma ; Dwarfism ; Dwarfism, Pituitary ; Gonadotropin-Releasing Hormone ; Humans ; Levodopa ; Male ; Pituitary Gland ; Pituitary Gland, Anterior ; Pituitary Gland, Posterior ; Prolactin

Ectopic pituitary adenoma, occurring outside the sella turcica without any continuity with intrasellar pituitary gland is very rare. So far, less than 90 such cases have been reported in the literature. Regarding to ectopic locations, suprasellar region, sphenoid sinus and clivus have been reported in decending order of frequency. To our best knowledge, growth hormonesecreting ectopic pituitary adenoma in the clivus has never been reported. With the pertinent literature review, we present our unique case with its characteristic magnetic resonance imaging and immunohistochemical features.
Cranial Fossa, Posterior* ; Growth Hormone-Secreting Pituitary Adenoma* ; Magnetic Resonance Imaging ; Pituitary Gland ; Pituitary Neoplasms ; Sella Turcica ; Sphenoid Sinus

Diabetes insipidus(DI) of central origin is a clinical syndrome resulting from low blood levels of antidiuretic hormone secreted from the posterior lobe of the pituitary gland, which is usually caused by lesions involving the hypothalamus-neurohypophyseal axis. MR imaging can reveal absence of the posterior pituitary bright signal(PPBS)in DI. The authors reviewed four patients with intracranial germinomas who had DI due to hypothalamus involvement. All patients before radiotherapy revealed absence of PPBS on MRI. Three cases recovered from DI after radiotherapy and showed reappearance of PPBS. Another one patients who continued DI didn't show signal change of the posterior pituitary gland. Ws speculated that the reappearance of PPBS is related to clinical improvement of DI.
Diabetes Insipidus* ; Follow-Up Studies* ; Germinoma* ; Humans ; Hypothalamus ; Magnetic Resonance Imaging ; Pituitary Gland ; Pituitary Gland, Posterior ; Radiotherapy*

Hypopituitarism is not a common cause of delayed puberty, however it should always be considered, especially if there are such signs as severe dwarfism, dollish face, truncal obesity, small hands and feet, and microgenitalia. Either congenital or acquired, hypopituitarism can be resulted from hypothalamic and hypophyseal lesions. The clinical feature can be diverse depending on age of the patients, rate of progression, degree of hormone deficiency and characteristics of the lesion. The recent high interest in delayed puberty and the improved detection of hypothalamic hypophyseal lesions using combined pituitary fuction stimulation test, brain CT and MRJ, has made the differential diagnosis of hypopituitarism possible as the cause of delayed puberty. MRI has shown hypophyeal hypoplasia accompanied by anterior pituitary hypoplasia and ectopic neurohypophysis in some of the patients with hypopituitasm, and although the anatomical abnormality around the hypophysis in these patients is considered the reason for hypopituitarism, the pathogensis of which has not yet to be known. We, here, report a case of delayed puberty by hypopituitarism due to hypoplasia of anterior pituitary gland, pituitary stalk agenesis and ectopic neurohypophysis with brief review of the litereature.
Brain ; Diagnosis, Differential ; Dwarfism ; Foot ; Hand ; Humans ; Hypopituitarism ; Magnetic Resonance Imaging ; Obesity ; Pituitary Gland* ; Pituitary Gland, Anterior* ; Pituitary Gland, Posterior* ; Puberty, Delayed*

Pituitary stalk interruption syndrome (PSIS) involves the occurrence of a thin or absent pituitary stalk, hypoplasia of the adenohypophysis, and ectopic neurohypophysis. Diagnosis is confirmed using magnetic resonance imaging. Patients with PSIS have a variable degree of pituitary hormone deficiency and a wide spectrum of clinical manifestations. The clinical course of the disease in our patient is similar to that of a syndrome of inappropriate antidiuretic hormone secretion. This is thought to be caused by failure in the suppression of vasopressin secretion due to hypocortisolism. To the best of our knowledge, there is no case report of a patient with PSIS presenting with hyponatremia as the first symptom in Korean children. Herein, we report a patient with PSIS presenting severe recurrent hyponatremia as the first symptom, during adolescence and explain the pathophysiology of hyponatremia with secondary adrenal insufficiency.
Adolescent ; Adrenal Insufficiency* ; Child ; Delayed Diagnosis* ; Diagnosis ; Humans ; Hyponatremia* ; Hypopituitarism ; Inappropriate ADH Syndrome ; Magnetic Resonance Imaging ; Pituitary Gland* ; Pituitary Gland, Anterior ; Pituitary Gland, Posterior ; Vasopressins

The authors report two cases of lymphocytic hypophsitis: a 38-year-old male patient with headache and diabetes insipidus and in a 64-year-old female patient with headache. Magnetic resonance(MR) image of the patients showed mass-like lesions in the hypophysis as well as loss of high signal on T1-weighted MR images. There was evidence of hypopituitarism. Both patients underwent transsphenoidal approaches for histological diagnosis, which was compatable with lymphocytic hypophysitis. When MR image reveals a characteristic pituitary in the hypophysis lesion with relevant clinical symptoms in a patient, one should include "lymphocytic hypophysitis" as one of the diagnostic possibilities, since the therapeutic options are different from those of pituitary tumors.
Adult ; Diabetes Insipidus ; Diabetes Insipidus, Neurogenic ; Diagnosis ; Female ; Headache ; Humans ; Hypopituitarism ; Male ; Middle Aged ; Pituitary Gland ; Pituitary Gland, Posterior ; Pituitary Neoplasms

Lymphocytic infundibuloneurohypphysitis(LINH) is a newly classified disorder and proposed as a common cause of idiopathic central diabetes insipidus. It is characterized by thickening of the infundibulum and/or pituitary stalk and absence of high signal in the neurohypophysis in sellar MRI and the microscopic findings of diffuse lymphocytic infiltration within the neurohypophysis. A 12year-old boy presented polyuria and headache. The result of water deprivation test was compatible with central diabetes insipidus. Brain MRI showed thickening of the pituitary stalk and loss of high signal in the neurohypophysis. Craniotomy and excisional bi6opsy was done under the impression of pituitary tumor. Microscopically, neurohypophysis showed dense lymphocytic infiltration and no malignant cells. Six months after the operation, the previously thickened pituitary stalk and neurohypophysis appeared normal in follow-up MRI.
Brain ; Craniotomy ; Diabetes Insipidus, Neurogenic ; Follow-Up Studies ; Headache ; Humans ; Magnetic Resonance Imaging ; Male ; Pituitary Gland ; Pituitary Gland, Posterior ; Pituitary Neoplasms ; Polyuria ; Water Deprivation

We report a very rare case of atypical granular cell tumor arising in the neurohypophysis of a 56-year-old woman. The tumor was seen on radiology to be lobulated, soft and diffusely enhanced, the same as pituitary macroadenoma, but it was anatomically localized within the posterior part of the hypophysis. We partially removed the tumor via the transsphenoidal approach. The pathology showed nuclear pleomorphism, spindling features, and lymphoplasmacytic infiltration. Ki-67 and S-100 protein were focally positive in tumor cells. Histological diagnosis confirmed an atypical granular cell tumor in the sellar region, which is a rare tumor that often has the clinical appearance of a pituitary adenoma. Ophthalmologic symptoms are the most common, followed by endocrinologic manifestations. Here we describe its symptoms and radiological and pathological features.
Central Nervous System ; Diagnosis ; Female ; Granular Cell Tumor* ; Humans ; Middle Aged ; Pathology ; Pituitary Gland ; Pituitary Gland, Posterior ; Pituitary Neoplasms ; S100 Proteins

OBJECTIVE: Cancer pain has been treated by gamma knife radiosurgery(GKS), targeted to the pituitary gland-stalk, as an alternative new pain control method. The purpose of this study is to prove the efficacy and the safety of this treatment. METHODS: Seven patients with intractable cancer pain underwent pituitary gland-stalk irradiation by gamma knife. Selections for patient inclusion in this treatment protocol were no other effective pain treatment options, general condition rated as greater than 40 on Karnofsky Performance Scale, and pain relief by morphine though not satisfactory. The target was the junction between the pituitary stalk and the neurohypophysis. The maximum dose was 150~160Gy with one isocenter in 8mm collimator or two isocenters in 4mm collimator keeping the radiation dose to the optic nerve less than 8Gy. RESULTS: In all seven cases, the significant pain reduction was obtained during immediate post-GKS period without serious complications except one patient who developed transient hypopituitarism and diabetes insipidus. Pain relief was observed within several days, and this effect was prolonged for a quite long time. At a follow up of 1.5 to 13 months, pain recurred in two patients and no hormonal and visual dysfunctions were observed. CONCLUSION: Despite insufficient experience, the efficacy and the safety of GKS for intractable cancer pain were demonstrated in seven patients. This treatment has the potential to ameliorate cancer pain, and GKS will play a more important role in the treatment of intractable pain.
Clinical Protocols ; Diabetes Insipidus ; Follow-Up Studies ; Humans ; Hypopituitarism ; Morphine ; Optic Nerve ; Pain, Intractable ; Pituitary Gland ; Pituitary Gland, Posterior ; Pituitary Irradiation* ; Radiosurgery