The Clinical Feature And Prognosis Of Patients With Thickened Pituitary Stalk

Pituitary stalk thickening (PST), used as an imaging diagnosis, plays a major role in the early diagnosis and treatment of the hypothalamus and pituitary disease. Up until now, several lines of systematic investigations have been conducted among adolescents, and the results indicated that the patients with a combination of PST and central diabetes insipidus (CDI) have remarkably higher likelihood of developing neoplasia disease. However, given the special location of pituitary stalk, together with its atypical features of clinical manifestation, the limitation of diagnostic methods and the diversification of the pathogenesis, it presents still a great challenge to making constructive clinical decisions and providing accurate diagnosis.Part IAnalysis of 159 PST Patients:Clinical Feature, Pituitary Function, Imaging Presentation and Treatment SituationObjective:To describe the onset characterisitcs and the clinical presentations of PST, the sellar region MRI presentation and function of pituitary function owing to different pathogenesis, and review the effects of various treatments.Methods:We enrolled 159 patients (57 males and 102 females) with an average age of 27.6±15.6, who visited the Department of Endocrinology or Neurosurgery of Huashan Hospital and were indicated to have PST at the first MRI evaluation in the five year period from 2007 to 2012. The first time PST diagnosed were recorded, demography data were registered, clinical feature were discribed and pituitary function were assessed including gonadal axes, thyroid axes, adrenal axes, GH axes, prolactin and posterior pituitary function. The patients were then followed up for their further treatment and pathologic diagnosis. Excel 2003 was used for data recording, and SPSS 18.0 was used for statistical analysis.Results:Total number of patients included in the present study was 159, among which 57 were male and 102 were female. The mean age at the first diagnose of PST was 27.6±15.6 years.1.44% patients were from 10 years old to 25 years old, which is a large amonut of the study population.11.3% patients were from 30-35 years, and mostly were women(84.2%).2.90 patients(56.6%) were diagnosed as having polydipsia and polyuria, 37 patients(23.27%) had trouble in gonadal axes, including menstrual disorder.3. All the sellar region MRI were reviewed, and can be categorized to three groups:PST, PST with enlarged pituitary, PST with lesions in other region of brain. We found clinical presentations and pituitary function were different in these three patients.4. Among the patients who had their pituitary function assessed, GH and IGF-1 were measured in 31 patients and found to be low in 14 of them(45.2%). Hyperplactin was 41.8%(33/79) and secondary hypogonadism was 37.1%(26/70). Moreover, secondary adrenal insufficiency was present in 24 patient(34.8% of tested patients) and secondary thyroidism was 19.2%(15/78).5. Among all the patients,16.35% received radiotherapy and 6.92% had a surgery.5 patients had immune-suppress therapy,31.45% only had medicines to release the symptoms, which consisted the biggest part of PST patients. Conclusions:PST are commonly seen in the women in the childbearing age and teenagers in the adolescence, and most of them are revealed to have symptoms of diabetes insipidus. Most patients appears to be PST only on MRI, and we found imaging feature had a correlation with clinical presentation and pituitary function. GH deficiency and secondary hypogonadism were more likely to happen in PST patients. Nowadays there are still a large amount of PST patients who didn’t have a clear diagnosis just receive medicine to control symptons.Part IIThe Development and Prognosis of PST PatientsObjective:To investigate the development and the prognosis of PST patients who had different pathomechanism, and to explore the pattern for PST diagnosis and treatment.Methods:All patients enrolled in part Ⅰ study had received a telephone follow-up, their further treatments and pathologic diagnosis were asked, regular sellar region MRI and pituitary function assessment were requested.Results:The total number of patients who received follow-up procedure is 76 (28 males and 48 females) with an average onset age of 26.4±15.7 and a median follow-up duration of 5.9±3.2 years.1. We found 7 patients whose pituitary stalk lesion shrunked itself, whereas 5 patients’ lesion enlarged during follow-up.4 of 5 patients who received immuno-suppressed therapy had improved in MRI. Meanwhile all 15 patients recovered on MRI after radiotherapy.2. During the observation,2 patients didn’t have pituitary deficiency in the nature history of the diesese, but 2 patients appears to have new pituitary deficiency after immuo-suppressed thearpy and radiotherapy respectively.3.8 patients recovered from their symptoms,29 were in remission,25 patients complained of no change and 4 died of the disease. It seems that the improvement of the clinical symptoms resulted from the therapy patient received.4. Through the analysis of neoplastic group and non-neoplastic group, we found statistical significance in the diagnose age of PST, in pituitary dysfunction between neoplastic and non-neoplastic.Conclusions:PST patients without any clinical presentations may caused by biological changes. Early age onset combined with CDI and hypopituitarism may help make better predictions about neoplasia. As for neoplastic lesions, we recommand radiotherapy, and for female patients during their childbearing age, immuno-suppressed therapy is the first choise. But the most important is the regular examination of sellar region MRI and the evaluation of pituitary function.