Pituitary Involvement by Wegener's Granulomatosis: A Report of Two Cases
Gregory L. Katzmana,
Carol A. Langforda,
Michael C. Snellera,
Myles Kobya and
Nicholas J. Patronas
,a
a From the Department of Radiology, Clinical Center (G.L.K., N.J.P.), and the National Institute of Allergy and Infectious Diseases (C.A.L., M.C.S.), National Institutes of Health, Bethesda, MD; and the Department of Radiology, University of Maryland Medical Center, Baltimore (M.K.).
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FIG 1. Case 1: MR findings in the sella turcica of 41-year-old woman with Wegener's granulomatosis.
A, Coronal T1-weighted (500/12/3) conventional spin-echo (CSE) image at initial presentation shows an enlarged pituitary gland (14 mm vertical height). The periphery of the pituitary is isointense with brain (arrows) whereas the remainder is hyperintense.
B, Coronal T1-weighted (500/12/3) CSE contrast-enhanced image shows enhancement of the periphery (arrows) of the pituitary gland whereas the remainder is relatively hypointense.
C, Coronal T2-weighted (2433/95/4) CSE image shows a subtle central area of hyperintensity (arrow) that is considerably smaller than the abnormality seen in A.
D, Sagittal T1-weighted (500/12/3) CSE contrast-enhanced image shows peripheral enhancement and a relatively hypointense center (black arrow) as well as minimal enhancement into hypothalamus (white arrows). The peripheral enhancing rim is broader in this image, which was obtained a few minutes after B. This was thought to be caused by the delayed enhancement by the more central tissues.
E, Coronal T1-weighted (400/9/4) CSE contrast-enhanced image after long-term immunosuppressive therapy shows the size of the pituitary gland has decreased to normal range (8 mm in height) with normal, uniform enhancement.
F, Sagittal T1-weighted (400/9/4) CSE image after immunosuppressive therapy shows persistent loss of normal posterior pituitary hyperintensity.
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FIG 2. Case 2: MR findings in the sella turcica of 18-year-old woman with Wegener's granulomatosis.
A, Coronal T1-weighted (500/12/3) CSE image at initial presentation shows an enlarged pituitary gland (15 mm vertical height).
B, Coronal T1-weighted (500/12/3) CSE contrast-enhanced image shows enhancing periphery with relatively hypointense center (arrows).
C, Coronal T2-weighted (2433/95/4) CSE image with central hyperintensity (arrows) corresponding to the relatively hypointense region.
D, Sagittal T1-weighted (500/12/3) CSE contrast-enhanced image shows enhancing periphery with relatively hypointense center (black arrow) as well as enhancement into hypothalamus (white arrows).
E, Coronal T1-weighted (400/9/4) CSE contrast-enhanced image after long-term immunosuppressive therapy shows size of pituitary gland has decreased to normal range (7 mm in height) with normal, uniform enhancement.
F, Sagittal T1-weighted (400/9/4) CSE image after immunosuppressive therapy shows persistent loss of normal posterior pituitary hyperintensity.
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