Article Figures & Data
Figures
- Fig 1.
Images from case 1, with typical findings of ectopic posterior pituitary lobe.
A, Unenhanced midline sagittal spin-echo T1-weighted image (625/13/4) shows hyperintensity corresponding to ectopic posterior pituitary lobe at the median eminence (short arrow). The pituitary gland and sella turcica are small, with a thin infundibulum (long arrow).
B, Coronal T1-weighted spoiled gradient-recalled image shows a small heterotopic nodule, isointense to gray matter, above the left trigone (arrow).
- Fig 2.
Images from case 2.
A, Unenhanced midline sagittal spin-echo T1-weighted image (625/13/4) shows a small hyperintensity at the median eminence typical of ectopic posterior pituitary lobe, with a second small hyperintensity extending downward into the upper infundibulum (arrows). The infundibulum is thinned, with a small pituitary gland and sella turcica. The splenium of the corpus callosum is small.
B, Axial fast spin-echo T2-weighted images (5200/102/3) show small heterotopic nodules isointense to gray matter, above the frontal horns (arrowheads).
- Fig 3.
Image from case 3. Unenhanced midline sagittal view spin-echo T1-weighted image (625/13/4) shows hyperintensity at the median eminence, typical for ectopic posterior pituitary lobe (short arrow). A small hyperintense focus can also be seen lying posterosuperiorly on the superior aspect of the small pituitary gland (curved arrow), which probably also represents ectopic pituitary tissue. The sella has an abnormal morphology, with a sloping anterior wall. It contains a thin layer of soft tissue lining the floor of the dysplastic anterior sella and more recognizable pituitary tissue in the base of the sella. The infundibulum is difficult to definitely identify because it is markedly thinned but may lie more anteriorly than usual (long arrow).
- Fig 4.
Images from case 4.
A, Unenhanced midline sagittal spin-echo T1-weighted image (625/13/4) shows two brightly hyperintense foci: one involving the mammillary bodies and the other in the interpeduncular cistern (black arrowheads). There is also a smaller less hyperintense focus located at the expected site of the median eminence, suggestive of ectopic posterior pituitary lobe (white arrow). The pituitary gland and sella are small, with a suggestion of a tiny posteriorly angled infundibulum.
B, Unenhanced sagittal spin-echo T1-weighted image (650/9/2) with fat suppression, obtained at the same position as the image shown in A, shows suppression of the two larger more posteriorly located hyperintensities (black arrowheads), indicating that these represent lipomas. The smaller anterior hyperintensity of ectopic posterior pituitary lobe does not suppress (white arrow). A little flow-related artifact is seen in the floor of the third ventricle between the median eminence and the mammillary bodies.
C, Contrast-enhanced sagittal spin-echo T1-weighted image (650/9/2) with fat suppression shows enhancement of the median eminence, confirming that the anterior hyperintensity lies at a typical location for ectopic posterior pituitary lobe (short arrow). Enhancement of the infundibulum can also be seen (long arrow). The two lipomas remain suppressed, with no enhancement (arrowheads).
Tables
Clinical Feature Case 1 Case 2 Case 3 Case 4 Age at presentation 2 yr 14 mo 5 yr 9 mo 3 yr 11 mo Sex M M M F Presenting symptoms Short stature, poor growth Short stature, poor growth, episodes suggesting hypoglycemia Short stature, poor growth Short stature, poor growth Height On 1st centile <1st centile <1st centile <1st centile Antenatal/perinatal events IUGR at 34 wk gestation, neonatal hypoglycemia Breech presentation, elective CS Neonatal hypoglycemia Maternal hypertension, forceps delivery for fetal distress Seizures 0 1 Generalized seizure 0 0 Family history 0 Cousin with epilepsy, maternal GM with anosmia 0 0 Vision/fundi Asymptomatic, n/t N Asymptomatic, n/t N Other examination findings Micropenis, small nasal dimple Micropenis 0 0 Maximum GH response to glucagon (normal >20 mI U/L) 19 27 3 3 Free thyroxine (normal range, 10–25 pmol/L) 7.2 Total T4 = 110 nmol/L (normal range, 70–155 nmol/L), TSH = 2.1 mIU/L (normal range, <5 mIU/L) 6.3 12.1 Plasma cortisol (8:30 am) (normal range, 200–750 nmol/L) 330 546 200 n/t Prolactin (normal range, 50–500 mIU/L) n/t n/t 40 76 Response to GH treatment On 15th centile >1st centile after 6 mo On 3rd centile (on GH, thyroxine, hydrocortisone) >25th centile HESX1 mutation 0 n/t n/t + (father and sister also have mutation) Note.—M indicates male; F, female; IUGR, intrauterine growth; CS, caesarian section; GM, grandmother; n/t, not tested; N, normal; 0, absent; GH, growth hormone; TSH, thyroid-stimulating hormone.
MR Imaging Finding Case 1 Case 2 Case 3 Case 4 Posterior pituitary lobe EPP EPP EPP Second EPP focus on posterosuperior aspect of gland EPP Anterior pituitary lobe Small Small Small Small Infundibulum Thin Thin, hyperintensity at root of infundibulum Markedly thin, anteriorly placed Thin Sella turcica Small Small Small, dysplastic anterior sella Small Periventricular heterotopia 2 Nodules, unilateral, posterior body of lateral ventricle Approximately 7 nodules, bilateral, frontal horns and bodies of lateral ventricles 2 Nodules, bilateral, right trigone, left temporal horn 1 Nodule, unilateral, left frontal horn Septum pellucidum/optic nerves N N N N Other abnormalities 0 Mild callosal dysgenesis 0 2 suprasellar lipomas Note.—EPP, ectopic posterior pituitary lobe; N, normal; 0, absent.
In this issue
Jump to section
Related Articles
Cited By...
- Genetic, Genomic and Biophysical Case Study: Familial 46, XY Sex Reversal due to a Novel Inherited Mutation in Human Testis-Determining Factor SRY
- Is it micropenis? Does size matter?
- Incidental findings on routine brain MRI scans in preterm infants
- Panhypopituitarism with Ectopic Posterior Pituitary Lobe, Heterotopia, Polymicrogyria, Corpus Callosum Dysgenesis, and Optic Chiasm/Nerve Hypoplasia: Is That an Undefined Neuronal Migration Syndrome?
- Teaching NeuroImages: Ectopic posterior pituitary
- Bilateral Posterior Periventricular Nodular Heterotopia: A Recognizable Cortical Malformation with a Spectrum of Associated Brain Abnormalities