IMAGING IN ANTERIOR PITUITARY GLAND DISEASES

PROF D.A. NZEH

DEPARTMENT OF RADIOLOGY UNIVERSITY OF ILORIN ILORIN

ANATOMICAL CONSIDERATIONS IN THE PITUITARY GLAND

ANTERIOR PITUITARY GLAND (ADENOHYPOPHYSIS) Highly vascular Very cellular: Consists of chromophobe, eosinophilic and basophylic cells. POSTERIOR PITUITARY GLAND (NEUROHYPOPHYSIS) Made up of nerve fibres connected to the hypothalamus. PARS INTERMEDIA Contains large colloid vesicles similar to the thyroid gland.

PHYSIOLOGICAL CONSIDERATIONS IN THE PITUITARY GLAND

ANTERIOR PITUITARY GLAND Hormones secreted (six) Growth hormone. Adrenocoticotrophin hormone (ACTH). Thyroid stimulating hormone (TSH). Follicle stimulating hormone (FSH). Luteinizing hormone (LH). Prolactin. POSTERIOR PITUITARY GLAND Hormones secreted (two) Antidiuretic hormone (ADH) Oxytocin

PATHOLOGICAL CONSIDERATIONS IN THE PITUITARY GLAND

Pituitary tumours are generally classified as either endocrine active or endocrine inactive. TUMOURS OF THE PITUITARY GLAND MACROADENOMA Usually > 10mm in size. Form intracranial space-occupying lesions. May compress the optic chiasma and cause visual disturbances ( Typically causes bitemporal hemianopia). MICROADENOMA Usually < 10mm in size. Cause endocrine disturbances.

CLINICAL FEATURES IN PITUITARY GLAND DISEASES

CHROMOPHOBE ADENOMA Tumour itself is non-secretory but destroys normal functioning gland. Patient develops hypopituitarism with loss of sex characteristics, hypothyroidism and hypoadrenalism. In childhood, there is arrest of growth. Extension of tumour to the hypothalamus results in diabetes insipidus and obesity. EOSINOPHIL ADENOMA Secretes GH. When it is present before puberty (unusual), gigantism occurs. After puberty it causes acromegaly.

BASOPHIL ADENOMA Small and does not produce pressure effect. May be associated with Cushings syndrome. PROLACTINOMAS Manifests with gonadal malfunction sometimes causing galactorrhea.

IMAGING MODALITIES TO EVALUATE DISEASES THE PITUITARY GLAND

Computed Tomography. Magnetic Resonance Imaging. Angiography Plain Skull Radiograph. Single photon Emission Computed Tomography (SPECT). Positron Emission Tomography (PET).

DISEASES OF THE ANTERIOR PITUITARY GLAND

COMPUTED TOMOGRAPHY
PITUITARY MACROADENOMA

Shows destruction of sella floor by tumour. Demonstrates enlarged sella. Shows extent of suprasellar extension in large tumours. Sagittal and coronal reformation after i.v. contrast helps to outline of a adenoma due to good enhancement. Demonstrates chiasmal compression in large tumours.

DISEASES OF THE ANTERIOR PITUITARY GLAND

COMPUTED TOMOGRAPHY
PITUITARY MICROADENOMA Difficult to demonstrate on CT due to beam hardening artefacts. Requires high resolution CT with direct coronal sections. Contiguous 1.5mm sections are obtained after contrast enhancement. Appears as a small hypodense area within the enhancing gland. May show deviation of the infundibulum. Bulging of the upper surface of the gland may be present.

DISEASES OF THE ANTERIOR PITUITARY GLAND

MAGNETIC RESONANCE IMAGING

PITUITARY MACROADENOMA
Preferred imaging modality for pituitary gland assessment. Demonstrates chiasmal compression in large tumours. MRI shows relationship of tumor with sphenoid sinus and carotid vessels well. High signal intensity of marrow fat in the clivus is well shown. Tumor is of relatively lower signal intensity to normal brain on T1W and higher signal intensity on T2W images. Areas of cyst formation or necrosis may show low signal intensity on T1W or high signal intensity of T2W sequences. Recent hemorrhage inside a tumor mass shows signal intensity on T2W images.

DISEASES OF THE ANTERIOR PITUITARY GLAND

MAGNETIC RESONANCE IMAGING

PITUITARY MICROADENOMA

Difficult to differentiate microadenoma from normal gland tissue. Gadolinium-DTPA injection shows delayed enhancement of the adenoma compared to normal gland. Dynamic contrast enhanced MRI may improve sensitivity in detection of microadenomas.

DISEASES OF THE ANTERIOR PITUITARY GLAND

PLAIN SKULL RADIOGRAPH

PITUITARY MACROADENOMA
Increase in size,expansion and erosion of a ballooned sella. Backward bowing of the dorsum. Undercutting of the anterior clinoid process. Downward protrusion of the sella floor into the sphenoid bone or sinus. In acromegaly the skull may show grossly enlarged sinuses, thickening of the skull vault, and prognathous jaw.

PITUITARY MICROADENOMA
May produce local bulging of the sella floor. Double floor sella but this sign may also be present in the normal skull.

DISEASES OF THE ANTERIOR PITUITARY GLAND

PLAIN SKULL RADIOGRAPH

DIFFERENTIAL DIAGNOSIS OF PITUITARY MACROADENOMA

It may be difficult to differentiate pituitary tumor from raised intracranial pressure . The empty sella shows more globular and symmetrical enlargement but the cortex of the sella remains intact.

DISEASES OF THE ANTERIOR PITUITARY GLAND

CATHETER ANGIOGRAPHY
PITUITARY MACROADENOMA Lateral displacement of the both carotid arteries in the frontal view.
Upward bowing of the anterior cerebral artery in the lateral view. Tumour blush may be present in a large mass.

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