title: Predictors of neoplastic disease in children with isolated pituitary stalk thickening.
abstract: BACKGROUND
  The significance of pituitary stalk thickening (PST) on magnetic resonance imaging (MRI) is often unclear. We evaluated presenting symptoms, MRI findings, clinical course, and outcome predictors of patients with PST.
  
  
  METHODS
  We used a computerized search of the medical record from 1995 to 2008 to identify patients with PST without pituitary mass on MRI. Baseline and follow-up MRIs were reviewed in a blinded fashion. Relevant clinical data were abstracted.
  
  
  RESULTS
  69 patients with reported PST and adequate imaging for review were identified; 42 met study criteria. Median age at first abnormal MRI was 13.6 years (range: 0.8-19.7); 43% were male. Median follow-up was 3.4 years (range 0-12.8). Patients with diabetes insipidus (DI) were significantly more likely to have a neoplastic process than those without (P = 0.0008). Of 16 patients with DI, 8 (50%) had a neoplastic process, including germ cell tumor (n = 4), Langerhans cell histiocytosis (n = 3), and lymphoma (n = 1). Among patients with DI, 7 (44%) also developed anterior pituitary hormone dysfunction (APD), either at presentation or on pre-biopsy follow-up, including 6/8 patients with stalk neoplasm and only 1/8 patients with non-neoplastic PST (P = 0.04). Twenty-six patients presented without DI; none was found to have neoplasm of the stalk except one patient with craniopharyngioma. Progression of PST on follow-up imaging was significantly associated with a subsequent neoplastic diagnosis (P = 0.04).
  
  
  CONCLUSIONS
  Patients with PST without DI are unlikely to have a neoplastic process. Among patients with DI, APD or progressive stalk increase over time are predictive of neoplasia.
authors.affiliation: Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Robison
authors.forename: Sanjay P
authors.initials: SP
authors.lastname: Prabhu
authors.forename: Pengling
authors.initials: P
authors.lastname: Sun
authors.forename: Susan N
authors.initials: SN
authors.lastname: Chi
authors.forename: Mark W
authors.initials: MW
authors.lastname: Kieran
authors.forename: Peter E
authors.initials: PE
authors.lastname: Manley
authors.forename: Laurie E
authors.initials: LE
authors.lastname: Cohen
authors.forename: Liliana
authors.initials: L
authors.lastname: Goumnerova
authors.forename: Edward R
authors.initials: ER
authors.lastname: Smith
authors.forename: R Michael
authors.initials: RM
authors.lastname: Scott
authors.forename: Wendy B
authors.initials: WB
authors.lastname: London
authors.forename: Nicole J
authors.initials: NJ
authors.lastname: Ullrich
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003919:Diabetes Insipidus / Q000150:complications* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008499:Medical Records; D009369:Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D009929:Organ Size; D010900:Pituitary Diseases / Q000150:complications* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D010902:Pituitary Gland / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011859:Radiography; D012189:Retrospective Studies
keywords: Langerhans cell histiocytosis; diabetes insipidus; germ cell tumor; germinoma; infundibulum; pituitary stalk thickening