Neuroendocrine Imaging

D.J. Seidenwurm

Imaging of the hypothalamic pituitary axis is based on specific endocrine testing suggested by clinical signs and symptoms. Endocrine disorders are generally characterized by excess or deficiency of specific hormones. Hormone excess is diagnosed under conditions that would ordinarily suppress hormone secretion. Endocrine deficiencies are diagnosed on the basis of hormone measurements under conditions of stimulation. Specific clinical syndromes of hormonal disorders are determined by the physiologic role of that particular hormone.

The hypothalamic pituitary axis consists of 2 separate neuroendocrine organs, the anterior and posterior pituitary systems. The hormones of the anterior pituitary are thyroid stimulating hormone (TSH), adrenal corticotrophic hormone (ACTH), prolactin (PRL), growth hormone (GH), and the gonadotropins (FSH and LH). These are secreted under the influence of hypothalamic trophic factors, corticotrophin releasing factor (CRF), thyrotropin releasing factor (TRF), and somatostatin- and gonadotropin- releasing hormone (GnRH). Prolactin release is under the control of a dopaminergic circuit. The hypothalamic-releasing hormones are transported to the pituitary gland by the hypophyseal portal system.

The posterior pituitary gland consists of axonal terminations of neurons whose cell bodies are located in the hypothalamus. The principal hormones secreted by these cells are oxytocin and vasopressin or antidiuretic hormone (ADH). The hypothalamus also participates in complex mediation of food intake, temperature regulation, sleep and arousal, memory, thirst, and other autonomic functions.

Structural causes of obesity, anorexia, central hypothermia and hyperthermia, insomnia, and hypersomnia are only very rarely demonstrated. Imaging in these patients absent other specific neurologic or endocrine abnormality is almost always unrewarding. An exception is children in whom the “diencephalic syndrome” of hypothalamic lesions is relatively common.

Pituitary adenomas are the most common lesions of the pituitary gland. These may secrete prolactin, TSH, GH, ACTH, or gonadotropins. Prolactinomas most commonly present as microadenomas in premenopausal females with amenorrhea and galactorrhea. Prolactin elevation by itself is nonspecific and may be due to a variety of medical, neurologic, or pharmacological causes as well as pituitary adenoma, depending on serum hormone level. In males, prolactinomas may be entirely asymptomatic until visual symptoms occur, due to compression of the chiasm, or they may result in hypogonadotropic hypogonadism with loss of libido and impotence. Growth-hormone-secreting tumors generally are larger lesions manifesting clinical acromegaly. Because of the gradual onset of deformity, these tumors may be present for many years and grow to substantial size. Before puberty excessive GH may result in gigantism. TSH- and ACTH-secreting tumors may present at very small size because the impact of their hormone product is usually apparent more rapidly. Gonadotropin-secreting tumors are rare.

Precocious puberty and other neurologic symptoms can be produced by hypothalamic lesions such as hamartoma. MR imaging is generally indicated in all patients with endocrinologically confirmed precocious puberty, especially when rapid progression of development and neurologic symptoms are present.

Posterior pituitary dysfunction with loss of antidiuretic hormone results in diabetes insipidus. This may be transient after trauma or neurosurgical procedures. Imaging is performed to search for the cause of stalk transsection, which can be a manifestation of numerous sellar or parasellar pathologies, trauma, or congenital. Rarely, the hormone is absent developmentally. The syndrome of inappropriate ADH is usually due to an extracranial source. Frequently, a paraneoplastic phenomenon in small-cell lung carcinoma, though a variety of pulmonary diseases and pharmacological disturbances can result in syndrome of inappropriate anti-diuretic hormone.

Other common mass lesions that may affect the neuroendocrine system are germ-line tumors, meningioma, craniopharyngioma, and Rathke cleft cyst among others. Metastatic lesions may affect the sella. Sarcoid and other inflammatory processes occur in the sellar and suprasellar regions as well. Pituitary apoplexy is a syndrome of headache ophthalmoplegia and visual loss that results from pituitary hemorrhage. In the postpartum period, pituitary infarcts may occur, and hypophysitis is an uncommon disorder resulting in endocrine disturbance and other symptoms.

MR imaging with thin-section multiplanar imaging often before and after contrast administration is the most useful test for these indications. Supplemental techniques include CT angiography (CTA), MR angiography (MRA), direct conventional angiography, and petrosal sinus sampling.

Plain radiography and pluridirectional tomography are insensitive and nonspecific. Pituitary microadenoma and macroadenomas are frequently associated with a normal sella size. The sella turcica can be enlarged when no neoplasm or mass is present. This is due to pulsations of cerebral spinal fluid (CSF) transmitted through a developmental or acquired dehiscence of the diaphragm sella in the empty sella syndrome. Therefore, these imaging modalities are rarely, if ever, useful here.

CT especially with intravenous contrast, to depict pathology within the unenlarged sella, occasionally facilitates diagnosis of neuroendocrine abnormality. Pituitary microadenomas and macroadenomas are often detected. There is difficulty in distinguishing tumor from the optic chiasm, diagnosis of cavernous sinus invasion is difficult, and cystic suprasellar masses may be confused with normal CSF. Additionally, artifact due to dental amalgam, difficulty in obtaining reliable contrast enhancement, and awkward positioning for direct coronal scanning limit utility. In the hands of experienced radiologists this technique can be useful, though the examinations are frequently difficult to interpret despite excellent technique.

MR imaging provides excellent noninvasive evaluation of the hypothalamus and pituitary gland. It is the only imaging technique that reliably depicts the hypothalamus usefully. It depicts the anatomy of the pituitary gland, infundibulum, optic chiasm, cavernous sinuses, and neighboring vascular structures accurately and noninvasively. The addition of gadolinium facilitates diagnosis of microadenoma and increases the confidence with which cavernous sinus invasion can be diagnosed or excluded. The specific bony landmarks are sometimes difficult to demonstrate, but sphenoid sinus mucosal signal intensity permits assessment of septa for operative planning. Visualization of vascular parasellar structures such as intrasellar carotid artery loop or aneurysm is crucial in some cases.

Angiography is reserved for those patients in whom vascular pathology is known or suspected on the basis of clinical or radiologic findings. Aneurysm is the most important vascular lesion in the parasellar region, but these lesions rarely present as endocrine disorders. Knowledge of vascular anatomy guides surgery. Occasionally, a sellar lesion may displace or encase the carotid arteries or other major intracranial vessels. Interventional neuroradiology procedures can be planned on the basis of CTA, MRA, and/or conventional angiography.

Petrosal sinus venous sampling is only performed when there is definite excess of pituitary hormone, medical management has failed, sectional imaging is negative or equivocal and surgery is planned. When significant differences in hormone level, usually ACTH, exists among the vessels studied, tumor localization is very accurate. Complications occur uncommonly in experienced hands.

A significant problem in CT and MR imaging of the pituitary, particularly when endocrine findings suggest microadenoma, is the false-positive examination. Since the endocrine studies confirm the presence of a lesion, and first-line therapy is usually medical, false-negative examinations are less problematic once chiasmatic compression has been excluded. Approximately 20% of the population may harbor incidental nonfunctioning adenomas or cysts. It is important, therefore, that the probability of disease be high in the target population if a positive MR imaging is to be relied upon for surgical planning. Additional problems are created by variations in size of the pituitary gland, which occur normally in response to physiologic hormonal changes. The gland may enlarge in puberty and pregnancy. Pituitary hyperplasia in hypothyroidism may simulate a pituitary adenoma in some patients. Similar problems arise in imaging the posterior pituitary, since up to 29% of normal subjects do not demonstrate a bright posterior pituitary.

Review Information

This guideline was originally developed in 1999. The last review and update was completed in 2007.

Appendix

Expert Panel on Neurologic Imaging: David J. Seidenwurm, MD, Principal Author and Panel Chair, Radiologic Associates of Sacramento, Sacramento, Calif; Patricia C. Davis, MD; James A. Brunberg, MD; Robert Louis De La Paz, MD; Pr. Didier Dormont; David B. Hackney, MD; John E. Jordan, MD; John P. Karis, MD; Suresh Kumar Mukherji, MD; Patrick A. Turski, MD; Franz J. Wippold II, MD; Robert D. Zimmerman, MD; Michael W. McDermott, MD, American Association of Neurlogical Surgeons; Michael A. Sloan, MD, MS, American Academy of Neurology.^1–44

Footnotes

This article is a summary of the complete version of this topic, which is available on the ACR Website at www.acr.org/ac. Practitioners are encouraged to refer to the complete version.
Reprinted with permission of the American College of Radiology.

Bibliography

↵
Argyropoulou M, Perignon F, Brauner R, et al. Magnetic resonance imaging in the diagnosis of growth hormone deficiency. J Pediatr 1992;120:886–91
CrossRef PubMed
Bonneville JF, Cattin F, Dietemann JL. Hypothalamic-pituitary region: computed tomography imaging. Baillieres Clin Endocrinol Metab 1989;3:35–71
CrossRef PubMed
Bozzola M, Mengarda F, Sartirana P, et al. Long-term follow-up evaluation of magnetic resonance imaging in the prognosis of permanent GH deficiency. Eur J Endocrinol 2000;143:493–96
Abstract
Carr DH, Sandler LM, Joplin GF. Computed tomography of sellar and parasellar lesions. Clin Radiol 1984;35:281–86
CrossRef PubMed
Chakeres DW, Curtin A, Ford G. Magnetic resonance imaging of pituitary and parasellar abnormalities. Radiol Clin North Am 1989;27:265–81
PubMed
De Herder WW, Lamberts SW. Imaging of pituitary tumours. Baillieres Clin Endocrinol Metab 1995;9:367–89
CrossRef PubMed
Debeneix C, Bourgeois M, Trivin C, et al. Hypothalamic hamartoma: comparison of clinical presentation and magnetic resonance images. Horm Res 2001;56:12–18
CrossRef PubMed
Dietemann JL, Cromero C, Tajahmady T, et al. CT and MRI of suprasellar lesions. J Neuroradiol 1992;19:1–22
PubMed
Donovan JL, Nesbit GM. Distinction of masses involving the sella and suprasellar space: specificity of imaging features. AJR Am J Roentgenol 1996;167:597–603
PubMed
Doraiswamy PM, Krishnan KR, Figiel GS, et al. A brain magnetic resonance imaging study of pituitary gland morphology in anorexia nervosa and bulimia. Biol Psychiatry 1990;28:110–16
CrossRef PubMed
Elster AD. Imaging of the sella: anatomy and pathology. Semin Ultrasound CT MR 1993;14:182–94
CrossRef PubMed
Escourolle H, Abecassis JP, Bertagna X, et al. Comparison of computerized tomography and magnetic resonance imaging for the examination of the pituitary gland in patients with Cushing's disease. Clin Endocrinol (Oxf) 1993;39:307–13
PubMed
Freeman JL, Coleman LT, Wellard RM, et al. MR imaging and spectroscopic study of epileptogenic hypothalamic hamartomas: analysis of 72 cases. AJNR Am J Neuroradiol 2004;25:450–62
Abstract/FREE Full Text
Glick RP, Tiesi JA. Subacute pituitary apoplexy: clinical and magnetic resonance imaging characteristics. Neurosurgery 1990;27:214–18; discussion 18–19
PubMed
Goldstein SJ, Lee C, Carr WA, et al. Magnetic resonance imaging of the sella turcica and parasellar region. A clinical-radiographic evaluation with computed tomography. Surg Neurol 1986;26:330–37
CrossRef PubMed
Grunt JA, Midyett LK, Simon SD, et al. When should cranial magnetic resonance imaging be used in girls with early sexual development? J Pediatr Endocrinol Metab 2004;17:775–80
PubMed
Guy RL, Benn JJ, Ayers AB, et al. A comparison of CT and MRI in the assessment of the pituitary and parasellar region. Clin Radiol 1991;43:156–61
CrossRef PubMed
Harrison MJ, Morgello S, Post KD. Epithelial cystic lesions of the sellar and parasellar region: a continuum of ectodermal derivatives? J Neurosurg 1994;80:1018–25
CrossRef PubMed
Hershey BL. Suprasellar masses: diagnosis and differential diagnosis. Semin Ultrasound CT MR 1993;14:215–31
CrossRef PubMed
Hirsch WL, Jr., Hryshko FG, Sekhar LN, et al. Comparison of MR imaging, CT, and angiography in the evaluation of the enlarged cavernous sinus. AJR Am J Roentgenol 1988;151:1015–23
PubMed
Isaacs RS, Donald PJ. Sphenoid and sellar tumors. Otolaryngol Clin North Am 1995;28:1191–229
PubMed
Jafar JJ, Crowell RM. Parasellar and optic nerve lesions: the neurosurgeon's perspective. Radiol Clin North Am 1987;25:877–92
PubMed
Johnson MR, Hoare RD, Cox T, et al. The evaluation of patients with a suspected pituitary microadenoma: computer tomography compared to magnetic resonance imaging. Clin Endocrinol (Oxf) 1992;36:335–38
PubMed
Kasperlik-Zaluska A, Walecki J, Brzezinski J, et al. MRI versus CT in the diagnosis of Nelson's syndrome. Eur Radiol 1997;7:106–09
CrossRef PubMed
Levine PA, Paling MR, Black WC, et al. MRI vs. high-resolution CT scanning: evaluation of the anterior skull base. Otolaryngol Head Neck Surg 1987;96:260–67
PubMed
L'Huillier F, Combes C, Martin N, et al. MRI in the diagnosis of so-called pituitary apoplexy: seven cases]. J Neuroradiol 1989;16:221–37
PubMed
Lieberman S. Diseases of the pituitary. In: Fishman MC, et al., ed. Medicine. Philadelphia, Pa.: Lippincott-Raven Publishers;1996 :165
Longui CA, Rocha AJ, Menezes DM, et al. Fast acquisition sagittal T1 magnetic resonance imaging (FAST1-MRI): a new imaging approach for the diagnosis of growth hormone deficiency. J Pediatr Endocrinol Metab 2004;17:1111–14
PubMed
Lopez J, Barcelo B, Lucas T, et al. Petrosal sinus sampling for diagnosis of Cushing's disease: evidence of false negative results. Clin Endocrinol (Oxf) 1996;45:147–56
CrossRef PubMed
Lundin P, Bergstrom K, Thuomas KA, et al. Comparison of MR imaging and CT in pituitary macroadenomas. Acta Radiol 1991;32:189–96
PubMed
Macpherson P, Hadley DM, Teasdale E, et al. Pituitary microadenomas. Does Gadolinium enhance their demonstration? Neuroradiology 1989;31:293–98
CrossRef PubMed
Macpherson P, Teasdale E, Hadley DM, et al. Invasive v non-invasive assessment of the carotid arteries prior to trans-sphenoidal surgery. Neuroradiology 1987;29:457–61
CrossRef PubMed
Maghnie M, Triulzi F, Larizza D, et al. Hypothalamic-pituitary dwarfism: comparison between MR imaging and CT findings. Pediatr Radiol 1990;20:229–35
CrossRef PubMed
Naheedy MH, Haag JR, Azar-Kia B, et al. MRI and CT of sellar and parasellar disorders. Radiol Clin North Am 1987;25:819–47
PubMed
Ng SM, Kumar Y, Cody D, et al. Cranial MRI scans are indicated in all girls with central precocious puberty. Arch Dis Child 2003;88:414–18; discussion 14–18
Abstract/FREE Full Text
Nichols DA, Laws ER, Jr., Houser OW, Abboud CF. Comparison of magnetic resonance imaging and computed tomography in the preoperative evaluation of pituitary adenomas. Neurosurgery 1988;22:380–85
PubMed
Pellini C, di Natale B, De Angelis R, et al. Growth hormone deficiency in children: role of magnetic resonance imaging in assessing aetiopathogenesis and prognosis in idiopathic hypopituitarism. Eur J Pediatr 1990;149:536–41
CrossRef PubMed
Pisaneschi M, Kapoor G. Imaging the sella and parasellar region. Neuroimaging Clin N Am 2005;15:203–19
CrossRef PubMed
Rodriguez O, Mateos B, de la Pedraja R, et al. Postoperative follow-up of pituitary adenomas after trans-sphenoidal resection: MRI and clinical correlation. Neuroradiology 1996;38:747–54
CrossRef PubMed
Sade B, Mohr G, Vezina JL. Distortion of normal pituitary structures in sellar pathologies on MRI. Can J Neurol Sci 2004;31:467–73
PubMed
Sato N, Endo K, Ishizaka H, et al. Serial MR intensity changes of the posterior pituitary in a patient with anorexia nervosa, high serum ADH, and oliguria. J Comput Assist Tomogr 1993;17:648–50
PubMed
Terano T, Seya A, Tamura Y, et al. Characteristics of the pituitary gland in elderly subjects from magnetic resonance images: relationship to pituitary hormone secretion. Clin Endocrinol (Oxf) 1996;45:273–79
CrossRef PubMed
Tripathi S, Ammini AC, Bhatia R, et al. Cushing's disease: pituitary imaging. Australas Radiol 1994;38:183–86
PubMed
↵
Zucchini S, di Natale B, Ambrosetto P, et al. Role of magnetic resonance imaging in hypothalamic-pituitary disorders. Horm Res 1995;44 Suppl 3:8–14
CrossRef PubMed

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[1] ↵
Argyropoulou M, Perignon F, Brauner R, et al. Magnetic resonance imaging in the diagnosis of growth hormone deficiency. J Pediatr 1992;120:886–91
CrossRef PubMed

[2] Bonneville JF, Cattin F, Dietemann JL. Hypothalamic-pituitary region: computed tomography imaging. Baillieres Clin Endocrinol Metab 1989;3:35–71
CrossRef PubMed

[3] Bozzola M, Mengarda F, Sartirana P, et al. Long-term follow-up evaluation of magnetic resonance imaging in the prognosis of permanent GH deficiency. Eur J Endocrinol 2000;143:493–96
Abstract

[4] Carr DH, Sandler LM, Joplin GF. Computed tomography of sellar and parasellar lesions. Clin Radiol 1984;35:281–86
CrossRef PubMed

[5] Chakeres DW, Curtin A, Ford G. Magnetic resonance imaging of pituitary and parasellar abnormalities. Radiol Clin North Am 1989;27:265–81
PubMed

[6] De Herder WW, Lamberts SW. Imaging of pituitary tumours. Baillieres Clin Endocrinol Metab 1995;9:367–89
CrossRef PubMed

[7] Debeneix C, Bourgeois M, Trivin C, et al. Hypothalamic hamartoma: comparison of clinical presentation and magnetic resonance images. Horm Res 2001;56:12–18
CrossRef PubMed

[8] Dietemann JL, Cromero C, Tajahmady T, et al. CT and MRI of suprasellar lesions. J Neuroradiol 1992;19:1–22
PubMed

[9] Donovan JL, Nesbit GM. Distinction of masses involving the sella and suprasellar space: specificity of imaging features. AJR Am J Roentgenol 1996;167:597–603
PubMed

[10] Doraiswamy PM, Krishnan KR, Figiel GS, et al. A brain magnetic resonance imaging study of pituitary gland morphology in anorexia nervosa and bulimia. Biol Psychiatry 1990;28:110–16
CrossRef PubMed

[11] Elster AD. Imaging of the sella: anatomy and pathology. Semin Ultrasound CT MR 1993;14:182–94
CrossRef PubMed

[12] Escourolle H, Abecassis JP, Bertagna X, et al. Comparison of computerized tomography and magnetic resonance imaging for the examination of the pituitary gland in patients with Cushing's disease. Clin Endocrinol (Oxf) 1993;39:307–13
PubMed

[13] Freeman JL, Coleman LT, Wellard RM, et al. MR imaging and spectroscopic study of epileptogenic hypothalamic hamartomas: analysis of 72 cases. AJNR Am J Neuroradiol 2004;25:450–62
Abstract/FREE Full Text

[14] Glick RP, Tiesi JA. Subacute pituitary apoplexy: clinical and magnetic resonance imaging characteristics. Neurosurgery 1990;27:214–18; discussion 18–19
PubMed

[15] Goldstein SJ, Lee C, Carr WA, et al. Magnetic resonance imaging of the sella turcica and parasellar region. A clinical-radiographic evaluation with computed tomography. Surg Neurol 1986;26:330–37
CrossRef PubMed

[16] Grunt JA, Midyett LK, Simon SD, et al. When should cranial magnetic resonance imaging be used in girls with early sexual development? J Pediatr Endocrinol Metab 2004;17:775–80
PubMed

[17] Guy RL, Benn JJ, Ayers AB, et al. A comparison of CT and MRI in the assessment of the pituitary and parasellar region. Clin Radiol 1991;43:156–61
CrossRef PubMed

[18] Harrison MJ, Morgello S, Post KD. Epithelial cystic lesions of the sellar and parasellar region: a continuum of ectodermal derivatives? J Neurosurg 1994;80:1018–25
CrossRef PubMed

[19] Hershey BL. Suprasellar masses: diagnosis and differential diagnosis. Semin Ultrasound CT MR 1993;14:215–31
CrossRef PubMed

[20] Hirsch WL, Jr., Hryshko FG, Sekhar LN, et al. Comparison of MR imaging, CT, and angiography in the evaluation of the enlarged cavernous sinus. AJR Am J Roentgenol 1988;151:1015–23
PubMed

[21] Isaacs RS, Donald PJ. Sphenoid and sellar tumors. Otolaryngol Clin North Am 1995;28:1191–229
PubMed

[22] Jafar JJ, Crowell RM. Parasellar and optic nerve lesions: the neurosurgeon's perspective. Radiol Clin North Am 1987;25:877–92
PubMed

[23] Johnson MR, Hoare RD, Cox T, et al. The evaluation of patients with a suspected pituitary microadenoma: computer tomography compared to magnetic resonance imaging. Clin Endocrinol (Oxf) 1992;36:335–38
PubMed

[24] Kasperlik-Zaluska A, Walecki J, Brzezinski J, et al. MRI versus CT in the diagnosis of Nelson's syndrome. Eur Radiol 1997;7:106–09
CrossRef PubMed

[25] Levine PA, Paling MR, Black WC, et al. MRI vs. high-resolution CT scanning: evaluation of the anterior skull base. Otolaryngol Head Neck Surg 1987;96:260–67
PubMed

[26] L'Huillier F, Combes C, Martin N, et al. MRI in the diagnosis of so-called pituitary apoplexy: seven cases]. J Neuroradiol 1989;16:221–37
PubMed

[27] Lieberman S. Diseases of the pituitary. In: Fishman MC, et al., ed. Medicine. Philadelphia, Pa.: Lippincott-Raven Publishers;1996 :165

[28] Longui CA, Rocha AJ, Menezes DM, et al. Fast acquisition sagittal T1 magnetic resonance imaging (FAST1-MRI): a new imaging approach for the diagnosis of growth hormone deficiency. J Pediatr Endocrinol Metab 2004;17:1111–14
PubMed

[29] Lopez J, Barcelo B, Lucas T, et al. Petrosal sinus sampling for diagnosis of Cushing's disease: evidence of false negative results. Clin Endocrinol (Oxf) 1996;45:147–56
CrossRef PubMed

[30] Lundin P, Bergstrom K, Thuomas KA, et al. Comparison of MR imaging and CT in pituitary macroadenomas. Acta Radiol 1991;32:189–96
PubMed

[31] Macpherson P, Hadley DM, Teasdale E, et al. Pituitary microadenomas. Does Gadolinium enhance their demonstration? Neuroradiology 1989;31:293–98
CrossRef PubMed

[32] Macpherson P, Teasdale E, Hadley DM, et al. Invasive v non-invasive assessment of the carotid arteries prior to trans-sphenoidal surgery. Neuroradiology 1987;29:457–61
CrossRef PubMed

[33] Maghnie M, Triulzi F, Larizza D, et al. Hypothalamic-pituitary dwarfism: comparison between MR imaging and CT findings. Pediatr Radiol 1990;20:229–35
CrossRef PubMed

[34] Naheedy MH, Haag JR, Azar-Kia B, et al. MRI and CT of sellar and parasellar disorders. Radiol Clin North Am 1987;25:819–47
PubMed

[35] Ng SM, Kumar Y, Cody D, et al. Cranial MRI scans are indicated in all girls with central precocious puberty. Arch Dis Child 2003;88:414–18; discussion 14–18
Abstract/FREE Full Text

[36] Nichols DA, Laws ER, Jr., Houser OW, Abboud CF. Comparison of magnetic resonance imaging and computed tomography in the preoperative evaluation of pituitary adenomas. Neurosurgery 1988;22:380–85
PubMed

[37] Pellini C, di Natale B, De Angelis R, et al. Growth hormone deficiency in children: role of magnetic resonance imaging in assessing aetiopathogenesis and prognosis in idiopathic hypopituitarism. Eur J Pediatr 1990;149:536–41
CrossRef PubMed

[38] Pisaneschi M, Kapoor G. Imaging the sella and parasellar region. Neuroimaging Clin N Am 2005;15:203–19
CrossRef PubMed

[39] Rodriguez O, Mateos B, de la Pedraja R, et al. Postoperative follow-up of pituitary adenomas after trans-sphenoidal resection: MRI and clinical correlation. Neuroradiology 1996;38:747–54
CrossRef PubMed

[40] Sade B, Mohr G, Vezina JL. Distortion of normal pituitary structures in sellar pathologies on MRI. Can J Neurol Sci 2004;31:467–73
PubMed

[41] Sato N, Endo K, Ishizaka H, et al. Serial MR intensity changes of the posterior pituitary in a patient with anorexia nervosa, high serum ADH, and oliguria. J Comput Assist Tomogr 1993;17:648–50
PubMed

[42] Terano T, Seya A, Tamura Y, et al. Characteristics of the pituitary gland in elderly subjects from magnetic resonance images: relationship to pituitary hormone secretion. Clin Endocrinol (Oxf) 1996;45:273–79
CrossRef PubMed

[43] Tripathi S, Ammini AC, Bhatia R, et al. Cushing's disease: pituitary imaging. Australas Radiol 1994;38:183–86
PubMed

[44] ↵
Zucchini S, di Natale B, Ambrosetto P, et al. Role of magnetic resonance imaging in hypothalamic-pituitary disorders. Horm Res 1995;44 Suppl 3:8–14
CrossRef PubMed

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