Pituitary stalk thickening in patients under 18 years of age – the most common causes and diagnostic procedures

Abstract

Introduction Pituitary stalk thickening (PST) is a rare abnormality in children, and it may be challenging due to its diverse clinical picture. The aim of the study is to summarize the data on the causes and diagnostic procedures of PST. Material and methods Papers were searched in the PubMed database identifying published randomized clinical trials, reviews, systematic reviews, meta-analyses, and case reports. Results The most common causes of a thickened pituitary stalk in children are germ cell tumours (GCTs), Langerhans cell histiocytosis (LCH), and lymphocytic infundibulo-neurohypophysitis (LINH). Neurosarcoidosis, pituitary tuberculosis, granulomatosis, or specific inflammations were only reported in the paediatric population as case studies. PST mainly affects teenagers and is often detected with brain magnetic resonance imaging (MRI) in patients with central diabetes insipidus (CDI). It is not possible to differentiate the causes of PST with the use of the MRI image alone. Although various biochemical and oncological markers and other imaging tests are used, the diagnosis of PST remains a significant diagnostic challenge for clinicians. The final diagnosis is made based on histopathological examination. The indications for a biopsy are not uniform. Most experts, including the authors of the 2021 British consensus, recommend biopsy in the case of PST with a stalk lesion diameter ≥ 6.5–7 mm. Conclusions The differential diagnosis of PST is a challenge. The diagnostic and treatment strategy should be individually adapted. Patients should be diagnosed in large clinical centres with experience in this field.

New developments and concepts in the diagnosis and management of diabetes insipidus (AVP‐deficiency and resistance)

“…In one recent study, only 0.6% of 160 patients (i.e., a single patient) with NFPAs presented with pre‐operative CDI 18 . The most common pathologies of sellar/parasellar lesions presenting with CDI are non‐adenomatous lesions, whereas the highest prevalence of CDI was found in less commonly encountered pathologies such as germ‐cell tumours (76.7%) 20 . Craniopharyngiomas and Rathke's cleft cyst represented 23.4% and 12.7% respectively of all sellar/parasellar lesions, with craniopharyngioma being the most common cause of CDI in children, and encountered in 25% 10,21 .…”

“…18 The most common pathologies of sellar/parasellar lesions presenting with CDI are non-adenomatous lesions, whereas the highest prevalence of CDI was found in less commonly encountered pathologies such as germ-cell tumours (76.7%). 20 Craniopharyngiomas and Rathke's cleft cyst represented 23.4% and 12.7% respectively of all sellar/parasellar lesions, with craniopharyngioma being the most common cause of CDI in children, and encountered in 25%. 10,21 The high incidence of CDI in craniopharyngiomas may be related to their embryological origin from the remnants of Rathke's pouch, as well as the more aggressive surgical approaches utilised, and usually persists after surgery.…”

Pediatrik Sella ve Parasellar Bolge Goruntulemesi

“…Germ hücreli tümörler çok erken dönemde pituiter infundibulumu infiltre ederek diabetes insipidusa neden olabilirler. Özellikle teknik olarak çok yeterli olmayan incelemelerde küçük lezyonlar gözden kaçabilir [14,15]. Merkezi diabetes insipidus ile prezente eden çocuklarda MRG negatif olsa bile germ hücreli tümör olasılığı tam olarak ekarte edilemediğinden 3-6 ay içinde incelemenin tekrarı önerilmektedir.…”

Incidence and Predictors for Oncologic Etiologies in Chinese Children with Pituitary Stalk Thickening

“…Isolated pituitary stalk thickening (PST) may be a result of neoplasms, such as germ cell tumors (GCTs) and Langerhans cell histiocytosis (LCH), inflammation, infection or congenital variants or can be idiopathic [6][7][8][9][10][11][12][13][14][15]. With the increasing use of magnetic resonance imaging (MRI) in the evaluation of probable growth and hormonal disturbances, PST is increasingly being diagnosed in children and adolescents [6,[16][17][18][19]. Given the potential morbidities and concerns regarding sampling errors in surgical biopsies, the management of children with PST represents a clinical conundrum for physicians [20][21][22][23][24][25][26].…”