Secondary adrenal insufficiency MRI

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

Overview

MRI is the diagnostic imaging modality used in secondary adrenal insufficiency to assess hypothalamic pituitary adrenal axis. MRI findings suggestive of pituitary abnormality may include a mass suggesting a tumor or empty sella leading to hypopituitarism.

MRI

MRI scan may show the following findings in cases of adrenal insufficiency due to hypopituitarism:^[1]
- Decreased size of the pituitary gland
- Empty sella may be noticed in some cases
- Pituitary stalk may be visible, thin, or totally absent
- Posterior lobe of the pituitary may be absent
- Mass may appear in the pituitary
- Pituitary adenomas with a diameter >1cm are thought to be associated with secondary adrenal insufficiency when compared to microadenomas
- Ectopic posterior lobe of the pituitary gland may be observed in cases of pituitary dwarfism
- Infiltrative disorders such a sarcoidosis and histiocytosis may present as thickening of infundibulum^[2]
- In central DI, T1 weighted MR shows absence of high internsity bright spot that is normally seen in posterior pituitary^[3]

Cystic lesions, such as Rathke’s cleft cysts may have
- A low-intensity signal on T1-weighted images
- A high-intensity signal on T2-weighted images

Empty Sella. Source: Wikimedia Commons^[4]

MRI showing necrotic pituitary adenoma (Source: Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 17664)

References

↑ Pozzi Mucelli, R. S.; Frezza, F.; Magnaldi, S.; Proto, G. (1992). “Magnetic resonance imaging in patients with panhypopituitarism”. European Radiology. 2 (1): 42–46. doi:10.1007/BF00714180. ISSN 0938-7994.
↑ Imashuku S, Kudo N, Kaneda S, Kuroda H, Shiwa T, Hiraiwa T, Inagaki A, Morimoto A (2011). “Treatment of patients with hypothalamic-pituitary lesions as adult-onset Langerhans cell histiocytosis”. Int. J. Hematol. 94 (6): 556–60. doi:10.1007/s12185-011-0955-z. PMID 22015494.
↑ De Herder WW, Lamberts SW (1995). “Imaging of pituitary tumours”. Baillieres Clin. Endocrinol. Metab. 9 (2): 367–89. PMID 7625990.
↑ “File:Empty Sella MRT FLAIR sag 001.jpg – Wikimedia Commons”. Text “Hellerhoff ” ignored (help)

Template:WikiDoc Sources

[Pozzi_MucelliFrezza1992-1] Pozzi Mucelli, R. S.; Frezza, F.; Magnaldi, S.; Proto, G. (1992). “Magnetic resonance imaging in patients with panhypopituitarism”. European Radiology. 2 (1): 42–46. doi:10.1007/BF00714180. ISSN 0938-7994.

[pmid22015494-2] Imashuku S, Kudo N, Kaneda S, Kuroda H, Shiwa T, Hiraiwa T, Inagaki A, Morimoto A (2011). “Treatment of patients with hypothalamic-pituitary lesions as adult-onset Langerhans cell histiocytosis”. Int. J. Hematol. 94 (6): 556–60. doi:10.1007/s12185-011-0955-z. PMID 22015494.

[pmid7625990-3] De Herder WW, Lamberts SW (1995). “Imaging of pituitary tumours”. Baillieres Clin. Endocrinol. Metab. 9 (2): 367–89. PMID 7625990.

[urlFile:Empty_Sella_MRT_FLAIR_sag_001.jpg_-_Wikimedia_Commons-4] “File:Empty Sella MRT FLAIR sag 001.jpg – Wikimedia Commons”. Text “Hellerhoff ” ignored (help)

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