title: Relationship between pituitary stalk (PS) visibility and the severity of hormone deficiencies: PS interruption syndrome revisited.
abstract: BACKGROUND
  Pituitary stalk interruption syndrome (PSIS) is a rare cause of combined pituitary hormone deficiency characterized by a triad shown in pituitary imaging, yet it has never been evaluated due to the visibility of pituitary stalk (PS) in imaging findings.
  
  
  OBJECTIVE
  The major objective of the study was to systematically describe the disease including clinical presentations, imaging findings and to estimate the severity of anterior pituitary hormone deficiency based on the visibility of the PS.
  
  
  METHODS
  This was a retrospective study including 74 adult patients with PSIS in Shanghai Clinical Center for Endocrine and Metabolic Diseases between January 2010 and June 2014. Sixty had invisible PS according to the findings on MRI, while the rest had a thin or intersected PS. Basic characteristics and hormonal status were compared.
  
  
  RESULTS
  Of the 74 patients with PSIS, age at diagnosis was 25 (22-28) years. Absent pubertal development (97·3%) was the most common presenting symptom, followed by short stature. Insulin tolerance test (ITT) and gonadotrophin-releasing hormone (GnRH) stimulation test were used to evaluate the function of anterior pituitary. The prevalence of isolated deficiency in growth hormone (GH), gonadotrophins, corticotrophin and thyrotrophin were 100%, 97·2%, 88·2% and 70·3%, respectively. Although the ratio of each deficiency did not vary between patients with invisible PS and with visible PS, panhypopituitarism occurred significantly more frequent in patients with invisible PS. Patients with invisible PS had significantly lower levels of luteinizing hormone (LH), follicle stimulation hormone (FSH) and hormones from targeted glands including morning cortisol, 24-h urine free cortisol, free triiodothyronine (FT3), free thyroxine (FT4) and testosterone (T) in male than patients with visible PS. Moreover, patients with invisible PS had lower peak LH and FSH in GnRH stimulation test, and higher peak cortisol in ITT while peak GH remained unchanged between two groups.
  
  
  CONCLUSIONS
  The prevalence of multiple anterior pituitary hormone deficiency was high in adult patients with PSIS. And more importantly, we found the visibility of PS shown on MRI might be an indication of the severity of PSIS.
authors.affiliation: Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases, Ruijin Hospital Affiliated to Shanghai Jiao-Tong University School of Medicine, Shanghai, China.|Laboratory for Endocrine and Metabolic Diseases of Institute of Health Science, Shanghai Jiaotong University School of Medicine and Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China.
authors.forename: Weiqing
authors.initials: W
authors.lastname: Wang
authors.affiliation: Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases, Ruijin Hospital Affiliated to Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
authors.forename: Shuwei
authors.initials: S
authors.lastname: Wang
authors.affiliation: Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases, Ruijin Hospital Affiliated to Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
authors.forename: Yiran
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Fuhua
authors.initials: F
authors.lastname: Yan
authors.affiliation: Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases, Ruijin Hospital Affiliated to Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
authors.forename: Tingwei
authors.initials: T
authors.lastname: Su
authors.affiliation: Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases, Ruijin Hospital Affiliated to Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
authors.forename: Weiwei
authors.initials: W
authors.lastname: Zhou
authors.affiliation: Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases, Ruijin Hospital Affiliated to Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Jiang
authors.affiliation: Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases, Ruijin Hospital Affiliated to Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
authors.forename: Yifei
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases, Ruijin Hospital Affiliated to Shanghai Jiao-Tong University School of Medicine, Shanghai, China.|Laboratory for Endocrine and Metabolic Diseases of Institute of Health Science, Shanghai Jiaotong University School of Medicine and Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China.
authors.forename: Guang
authors.initials: G
authors.lastname: Ning
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood / Q000172:deficiency; D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood / Q000172:deficiency; D006062:Gonadotropins / Q000097:blood / Q000172:deficiency; D013006:Growth Hormone / Q000097:blood / Q000172:deficiency; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000172:deficiency / Q000652:urine; D007986:Luteinizing Hormone / Q000097:blood / Q000172:deficiency; D008279:Magnetic Resonance Imaging; D008297:Male; D010900:Pituitary Diseases / Q000097:blood / Q000378:metabolism* / Q000503:physiopathology; D010902:Pituitary Gland / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000503:physiopathology; D010903:Pituitary Gland, Anterior / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000503:physiopathology; D010908:Pituitary Hormones, Anterior / Q000097:blood / Q000172:deficiency*; D011627:Puberty / Q000378:metabolism / Q000502:physiology; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013577:Syndrome; D013972:Thyrotropin / Q000097:blood / Q000172:deficiency; D013974:Thyroxine / Q000097:blood / Q000172:deficiency; D014284:Triiodothyronine / Q000097:blood / Q000172:deficiency; D055815:Young Adult
chemical_list: D006062:Gonadotropins; D010908:Pituitary Hormones, Anterior; D014284:Triiodothyronine; D000324:Adrenocorticotropic Hormone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D013972:Thyrotropin; D013006:Growth Hormone; D013974:Thyroxine; D006854:Hydrocortisone