Neuroimaging in posttraumatic hypopituitarism

Area of Science:

• Neurology
• Endocrinology

Background:

• Posttraumatic hypopituitarism results from damage to the hypothalamic-pituitary axis following traumatic brain injury.
• Clinical manifestations include decreased muscle mass, libido, fertility, concentration, and increased fatigue, depression, and cognitive deficits.
• Electrolyte imbalances, such as hyponatremia, can also occur.

Purpose of the Study:

• To highlight the increasing diagnosis of posttraumatic hypopituitarism.
• To outline the diagnostic approach, emphasizing clinical evaluation, laboratory testing, and neuroimaging.
• To present magnetic resonance imaging (MRI) as the preferred radiological technique for visualizing the pituitary gland.

Main Methods:

• Review of diagnostic criteria for posttraumatic hypopituitarism.
• Inclusion of coronal and sagittal MRI images of the posterior fossa.
• Illustration of normal hypothalamus and pituitary gland anatomy and adjacent structures.
• Depiction of the normal pituitary gland's sequential enhancement pattern related to vascular supply.

Main Results:

• MRI is the preferred imaging modality for the pituitary gland in suspected posttraumatic hypopituitarism.
• The enhancement pattern on MRI reflects the gland's vascular supply.
• Normal anatomy of the hypothalamus, pituitary stalk, and pituitary gland is illustrated.

Conclusions:

• Posttraumatic hypopituitarism is increasingly recognized following traumatic brain injury.
• Diagnosis relies on a combination of clinical assessment, lab tests, and neuroimaging, with MRI being key.
• Understanding the pituitary gland's vascular supply aids in MRI interpretation.