An endocrinological point of view on a large series of pituitary stalk lesions

Pituitary stalk lesions (PSL) present unresolved etiological and diagnostic challenges. This study provides a comprehensive clinical analysis to address these gaps.

We retrospectively evaluated 98 adults with pituitary stalk (PS) abnormalities, assessing PS features, demographics, clinical data, hormonal profiles, imaging, pathology, diagnoses, and treatments.

Among 98 patients (59 F/39 M; median age 37 years), PS thickening was most frequent (52%), followed by thinning (18.4%) and nodularity (17.3%). The distribution of lesion types varied significantly across etiological categories (p < 0.001). Thickening was most frequent in inflammatory etiologies, thinning in unclassifiable cases, and nodularity in inflammatory etiologies. Solid organ metastases occurred in older patients. Arginine vasopressin deficiency (AVP-D) rates ranged from 57% to 61% in non-adenomatous local neoplastic lesions, inflammatory etiologies, and solid organ metastases. Congenital cases mainly had growth retardation and gonadal dysfunction. Extrapituitary involvement was highest in solid organ metastases, followed by inflammatory etiologies, and non-adenoma local neoplastic lesions. PS thickening was more pronounced in solid organ metastases. Isolated PS involvement was most often (25%) due to Langerhans cell histiocytosis. In PSIS, all had ectopic neurohypophysis, lacked AVP-D, and showed at least one anterior pituitary hormone deficiency.

In conclusion, we describe a unique series of PSL that contribute to the understanding of the heterogeneous spectrum of PSL. In this study, we discuss the clinical and radiological features of PSL and provide current recommendations for differential diagnosis.