Hypophysitis: endocrinologic and dynamic MR findings

Abstract

Purpose: Our purpose was to assess the worth of dynamic MR imaging in the evaluation of vascular changes of the pituitary in patients with lymphocytic hypophysitis.

Methods: Five patients (four males, one female; 9 to 53 years old) with lymphocytic hypophysitis or infundibuloneurohypophysitis were studied. All patients underwent endocrinologic studies and a series of two to five MR examinations performed over a period of 8 months to 5 years, including a total of nine dynamic imaging studies.

Results: Two patients had panhypopituitarism and three had partial hypopituitarism. Diabetes insipidus was present in four patients. Among the five patients, the pituitary was enlarged in three, of whom two showed improvement on follow-up MR studies. Three patients had a thickened stalk, which improved on subsequent examinations. In all nine dynamic studies, the enhancement time of the whole pituitary was delayed to over 90 seconds, even though five of the nine conventional, simultaneously performed MR studies showed a normal pituitary. The peak time of posterior pituitary enhancement in the first dynamic study was also delayed in all patients (from 60 to 120 seconds). In two patients, normal early enhancement of the posterior pituitary was identified on initial studies but not on subsequent studies.

Conclusion: Dynamic MR imaging can display an abnormality of the hypophysial vasculature even if the pituitary disease is seen to regress on the conventional MR study. The delay or even the lack of early enhancement of the posterior pituitary in lymphocytic hypophysitis may be due to secondary inflammatory changes.