IMAGING RADIOLOGI KLINIS PADA

SISTEM ENDOKRIN DAN METABOLIK

DEPARTEMEN RADILOGI FAKULTAS
KEDOKTERAN UNIVERSITAS METHODIST
INDONESI

dr. Irene RT Damanik Sp. Rad (K) RA

 iMAGING OF THE PITUITARY GLAND
Tumors of the pituitary region include:
• Pituitary adenomas, classified on hormonal status and on size criteria
• Macroadenoma: >10 mm
• Microadenoma: <10 mm
• Pituitary carcinoma (rare)
• Meningioma
• Craniopharyngioma
• Metastasis
• Optic chiasm glioma (commonly associated with neurofibromatosis, type 1).
 Pituitary macroadenomas

Pituitary macroadenomas are the most

common suprasellar mass in
adults.They are defined as pituitary
adenomas greater than 10 mm in size
and are approximately twice as
common as pituitary microadenomas.

MRI of the pituitary demonstrates a large mass expanding

the sella and extending into the suprasellar cistern
compressing the optic chiasm. Within the right side of
the mass a region of intrinsic high T1 and T2 signal is
demonstrated (high T1 signal material is seen layering
posteriorly) consistent with subacute blood products
(extracellular methemoglobin).
 The Pineal gland

● The pineal gland is a small structure that typically measures less than 7mm in size, situated
in a groove between the laterally placed thalamus; above and posterior tothe superior
colliculi of the midbrain and below the internal cerebral veins.

● Masses in the pineal region have a relatively broad differential because of the variety of
cell types found in the region.

● Pineal germinomas are the most common tumor of the pineal region accounting for ~50%
of all tumors, and the majority (~80%) of intracranial germ cell tumors.
 Pineal gland mass – pineal germinoma
Mass lesion of the pineal region with hyperdense appearance
on native scans and intense enhancement. Hydrocephalus
with "pressure caps" resulting from aquaeduct obstruction.

These tumors tend to cluster in the midline, with a predilection

of the pineal and the suprasellar regions. Controversy persists
as to whether multifocal lesions, found at the time of diagnosis
in 5-10% of patients, represents synchronous tumors or
spread :
• pineal region: twice as common as all other sites
suprasellar region : next most common, suprasellar
/germinomas more common in women
• floor of the third ventricle
• basal ganglia: more likely germinoma
• thalamus: more likely germinoma
• fourth ventricle
 The adrenal gland
The adrenal gland is essentially made up of two separate organs, the adrenal
cortex and the adrenal medulla:
• Adrenal cortex: endocrine gland composed of fat-rich cells Secretes cortisol,
aldosterone and androgenic steroids
• Adrenal medulla: develops from the neural crest Secretes adrenaline and
noradrenaline.
• Indications for imaging of the adrenal glands include:
• Endocrine syndromes
• Cushing syndrome
• Hyperaldosteronism
• Suspected phaeochromocytoma
• Incidentally discovered adrenal mass.
 Cushing’s Syndrome
● Diseases of the Adrenal Cortex

● Radiographic Appearance: Generalized enlargement of the adrenal glands is

best demonstrated by computed tomography (CT), which shows thickening of
the wings of the adrenal gland, which appear to have a stellate or Y-shaped
configuration in cross section. Ultrasound can also show diffuse adrenal gland
enlargement.
 Cushing’s syndrome

Cushing’s syndrome caused by large Cushing’s syndrome caused by functioning cortical

adrenal adenoma. Nephrotomogram adenoma. A 4-cm mass in the left adrenal gland
demonstrates a huge suprarenal mass (arrows) can be seen posterior to the tail of the
(arrows) causing indentation and downward pancreas and anterior to the kidney (K). Arrowhead
displacement of left kidney. points to the normal right adrenal gland.
 Pheochromocytomas
● Pheochromocytomas are an uncommon tumor of the adrenal gland, with
characteristic clinical, and to a lesser degree, imaging features.
● Phaeochromocytoma is a tumour arising from chromaffin cells of the adrenal
medulla.
● 90 % occur in the adrenal gland and 10 % in ectopic extra-adrenal locations.
● 10% arise as part of a syndrome, e.g. multiple endocrine neoplasia, familial
phaeochromocytoma, tuberous sclerosis, and Von Hippel–Lindau disease,
neurofibromatosis.
● Phaeochromocytomas are usually large tumors, measuring up to 12 cm with an
average around 5 cm.
 Pheochromocytomas

CT abdomen and pelvis in four phases demonstrate a large

well-defined mass under the left hemidiaphragm that
promotes displacement of the left kidney inferiorly
and the spleen anteriorly. The tumor has large cystic
areas within and heterogeneous contrast
enhancement. No surrounding stranding or
lymphadenopathies were
identified.
 The Thyroid and parathyroid gland
Common clinical indications for imaging of the thyroid gland include:
● • Hyperthyroidism (Thyrotoxicosis).
● • Diffuse thyroid enlargement.
● • Focal thyroid mass or nodule.

● The most commonly used imaging techniques for the investigation of thyroid
diseases are:
● • Ultrasound.
● • US-guided fine needle aspiration (FNA).
● • Scintigraphy with 99mTc or radioiodine.
● • CT or MRI may be used to outline the anatomy of large goiters prior to
surgical removal, particularly where there is retrosternal extension into the
upper mediastinum.
 Diffuse thyroid enlargement

Causes of diffuse thyroid enlargement include:

● • Grave’s disease
● • Hashimoto thyroiditis
● • Subacute thyroiditis
● • Multinodular goiter.
 Graves disease
Thyroid gland is often enlarged and can be
hyperechoicheterogeneous thyroid echotexture
relative absence of nodularity in uncomplicated cases
hypervascular; may demonstrate a thyroid inferno pattern on
color Dopple
 thyroid nodules
US is the imaging investigation of choice for characterization of thyroid nodules.
• Features of thyroid nodules assessed with US include:
• Size: the incidence of cancer in nodules smaller than 1 cm is extremely low
• Composition: cystic, solid or mixed
• Margins: well-defined margin or ‘halo’; irregular margins
• Calcification: coarse or fine
• Vascularity.
 PRIMARY HYPERPARATHYROIDISM

Primary hyperparathyroidism is the most common

indication for imaging of the parathyroid glands.
• Causes of primary hyperparathyroidism:
• Solitary parathyroid adenoma: 80 %
• Multiple parathyroid adenomas: 7 %
• Parathyroid hyperplasia: 10 %
• Parathyroid carcinoma: 3 %

• Imaging is indicated in hyperparathyroidism to

localize the causative lesion prior to surgery.
 PRIMARY HYPERPARATHYROIDISM
US is the investigation of first choice.
• US with high-resolution equipment has a high sensitivity (80–90 %) for the
detection of parathyroid adenoma.
• US appearance of parathyroid adenoma is a well-defined hypoechoic mass
usually of around 1.0–1.5 cm in diameter.
• Most parathyroid adenomas lie behind or immediately below the thyroid gland.
• The principal cause of a false-negative US is ectopic adenoma, which may be
present in up to 10 % of cases; ectopic sites include mediastinum and carotid
sheath.
Ultrasound and nucelar medicine parathyroid adenoma

Parathyroid adenomas tend to be homogeneously hypoechoic

vs the overlying thyroid gland
an echogenic thyroid capsule separating the thyroid from the
parathyroid may be seen
 Skeletal disorder
● Acromegaly is the result of excessive growth hormone production in skeletally mature
patients, most commonly from a pituitary adenoma. The same excess of growth hormone
in individuals whose epiphyses have not fused will result in gigantism (excessively tall
stature).

● The remaining 5% of cases are the result of other tumors of the pancreas, lungs, or
adrenal glands that release growth hormone. A very small number of cases result from the
excessive use of exogenous growth hormone in athletes.
 acromegaly

2 cm enhancing lesion in the pituitary fossa, thickened skull

neanderthal like supraorbital ridge = frontal bossing
the thickened skull and frontal bossing suggest growth hormone secretion (i.e. acromegaly)
 acromegaly

AP view foot show a typical

"spade-like appearance" due to
prominent subungal tufts. Shafts
of metatarsal and phalanges
appear widened.
Note the heel pad thickness
of 29 mm which is Frontal and lateral view of spine demonstrate increased disc-facet and
significantly greater than intervertebral joint space with relatively mild kyphosis of lumbar
the cutoff value of 20 vertebrae. Hyperostosis of T11-L3 anterior vertebrae body noted.
mm in normal person Lower lumbar vertebrae also reveal posterior scalloping of vertebrae.​
according to age and
sex.
 TESTIS
● TORSIO TESTIS : terpeluntirnya funiculus spermatikus yang berakibat terjadinya
gangguan aliran darah pada testis.

Testicular torsion in a 13-year-old boy who presented with right scrotal

pain. The right testis is enlarged and appears heterogeneously
hypoechoic. Also, a complete absence of detectable flow is observed.
 HYDROCELE
● KUmpulan cairan serosa yang didapat atau kongenital di antara lapisan tunika vaginalis
yang mengelilingi testis atau korda spermatika.
 OVARIUM
● Ovarian cysts are commonly encountered in gynecological imaging and vary widely in
etiology from physiological to complex benign to neoplastic.
OVARIAN CYST - us
Thank you