title: Surgical biopsies in patients with central diabetes insipidus and thickened pituitary stalks.
abstract: Thickened pituitary stalks (TPSs) on magnetic resonance imaging (MRI) result from diverse pathologies; therefore, it is essential to make specific diagnoses for clinical decision-making. The diagnoses and indications for surgical biopsies in patients with central diabetes insipidus (CDI) and TPSs are thoroughly discussed in this paper. Thirty-seven patients with CDI and TPSs were retrospectively reviewed. The mean age at the diagnosis of CDI was 29.0 ± 15.9 years (range 8.0-63.3), and the median duration of follow-up was 5.5 ± 2.8 years (range 0.7-13.0). Anterior pituitary hormone deficiencies were documented in 26 (70.3 %) patients. All patients had a TPS on MRI at the diagnosis of CDI, and 21 (56.8 %) patients exhibited radiological changes during the follow-up. Of these 21 patients, 11 exhibited increases in the thickness of the stalk, and two patients exhibited reversals of the TPSs. Involvements of the hypothalamus, pituitary gland, basal ganglia or supersellar, and pineal gland were found in four, three, one, and 1 patient, respectively. Ultimately, clear diagnoses were established in 17 patients who underwent biopsies, nine of whom had germinomas, six of whom had Langerhans cell histiocytosis, one of whom had a granular cell tumor, and one of whom had Erdheim-Chester disease. Patients with CDI and TPSs should submit to periodic clinic follow-ups with serial MRI assessments to establish anterior pituitary deficiencies and to detect radiological progressions that are appropriate for surgical biopsies. Endoscopic-assisted microsurgery via the supraorbital keyhole approach is a good choice for the biopsy of pituitary stalk lesions.
authors: Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
authors: Fangfang
authors: F
authors: Jian
authors: Liuguan
authors: L
authors: Bian
authors: Shouyue
authors: S
authors: Sun
authors: Jun
authors: J
authors: Yang
authors: Xiao
authors: X
authors: Chen
authors: Yufan
authors: Y
authors: Chen
authors: Qinyun
authors: Q
authors: Ma
authors: Fei
authors: F
authors: Miao
authors: Weiqing
authors: W
authors: Wang
authors: Guang
authors: G
authors: Ning
authors: Qingfang
authors: Q
authors: Sun
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002648:Child; D020790:Diabetes Insipidus, Neurogenic / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006984:Hypertrophy; D007018:Hypopituitarism / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010902:Pituitary Gland / Q000473:pathology*; D012189:Retrospective Studies; D055815:Young Adult