Study On The Correlation Between MRI And Hormone Level Of Pituitary Target Axis And Clinical Symptoms In Men With Simple Thin Pituitary Stalk

Objective To investigate the relationship between pituitary MRI measurement and clinical symptoms in men with simple thin pituitary stalk,and to analyze its clinical significance.Methods A total of 108 patients who underwent pituitary MRI enhancement examination in the Department of Endocrinology of Ning Xia Medical University general hospital from December 2015 to December 2020 were collected.According to the inclusion and exclusion criteria,they were divided into subgroup A（≤30 years old）,subgroup B（31～40 years old）,subgroup C（41～50 years old）,subgroup D（51～60 years old）and subgroup E（≥61 years old）,the height of pituitary gland（sagittal）and the diameter of pituitary stalk（sagittal and coronal）were measured by GE ADW 4.2 workstation.According to the measurement results,62 cases were divided into the observation group（thin pituitary stalk group）and 46cases in the control group（normal pituitary stalk diameter group）.The differences of clinical manifestations,thyroid axis related hormones（FT3,FT4,TSH）,adrenal axis related hormones（F 8:00,UFC,ACTH）,gonadal axis related hormones（LH,FSH,TSTO,PRGE,PRL,e E2）between the two groups were analyzed to explore the relationship between patients with thin pituitary stalk and pituitary target axis hormone levels and clinical symptoms.Results 1.Clinical symptoms:among the 62 patients in the observation group,the clinical symptoms were dry mouth,polyuria,thirst,increased blood glucose by 67.74%,weight change by 35.48%,blurred vision by 27.42%,and the differences between the two groups were statistically significant（P<0.01）.Other symptoms included drowsiness,fatigue,dizziness,difficulty in falling asleep,increased blood pressure,loss of appetite,chest tightness,shortness of breath,joint pain,frequent urination,benign prostatic hyperplasia,constipation,etc.there was no significant difference between the two groups（P>0.05）.2.Laboratory examination:there was no significant difference in serum K⁺and Na⁺between the two groups（P>0.05）;there was significant difference in 25-（OH）D₃ between the two groups（P<0.01）.3.MRI pituitary stalk diameter:reference range of normal pituitary stalk at optic chiasm level:anteroposterior diameter（3.25±0.43）mm,transverse diameter（3.35±0.44）mm.In this study,the anterior posterior diameter was（1.67±0.38）mm in the observation group,and（2.68±0.32）mm in the control group.The transverse diameter was（1.64±0.42）mm in the observation group and（2.80±0.33）mm in the control group.There were significant differences in the anterior posterior diameter and transverse diameter at the level of optic chiasm between the two groups（P<0.01）.The reference range of normal pituitary stalk at the level of pituitary insertion:anteroposterior diameter（2.32±0.39）mm,transverse diameter（2.16±0.37）mm.The anteroposterior diameter of this study:the observation group（1.10±0.32）mm,the control group（1.99±0.31）mm,the transverse diameter:the observation group（1.10±0.32）mm,the control group（1.92±0.32）mm,the difference in the anteroposterior diameter and transverse diameter between the two groups was statistically significant（P<0.01）.4.Pituitary thyroid axis hormone level:the TSH level of the observation group was lower than that of the control group,the difference was statistically significant（P<0.01）,and there was no significant difference in FT3 and FT4 levels between the two groups（P>0.05）.In subgroup B、C,the level of TSH in the observation group was lower than that in the control group,and the difference was statistically significant（P<0.05）.5.Pituitary adrenal axis hormone level:ACTH level in the observation group was lower than that in the control group,the difference was statistically significant（P<0.01）,F 8:00 and UFC levels had no statistical significance（P>0.05）.The levels of In subgroup A,F 8:00 and UFC、ACTH in subgroups C in the observation group were lower than those in the control group,the difference was statistically significant（P<0.05）.6.Pituitary gonadal axis hormone levels:the levels of TSTO,PRGE and PRL in the observation group were lower than those in the control group（P<0.05）,but there was no significant difference in the levels of LH,FSH and e E2 between the two groups（P>0.05）.The levels of TSTO,PRGE in subgroup D、E and PRL in subgroup A,C and D in the observation group were lower than those in the control group（P<0.05）.7.Correlation analysis of pituitary MRI findings of observation group showed that pituitary stalk was slender and hormone levels of each axis:there was a correlation between optic chiasmatic level（sagittal,coronal）and LH,FSH（P<0.05）;optic chiasmatic level（sagittal,coronal）was negatively correlated with LH,FSH;among hormones,LH was positively correlated with FSH,TSTO.Conclusion 1.MRI showed that there were abnormal hormone levels of HPT,HPA and HPG axis in male patients with thin pituitary stalk,among which HPG>HPT>HPA axis.2.MRI findings of the thin pituitary stalk were correlated with the decreased levels of TSH,ACTH,TSTO,PRGE,PRL and 25-（OH）D3 in men,and with clinical symptoms such as dry mouth,polyuria,thirst,increased blood glucose,weight change and blurred vision.3.Pituitary MRI can be used for early screening of patients with no typical clinical symptoms or symptoms of occult pituitary stalk,and provide imaging basis for early clinical intervention.