Pituitary stalk transection syndrome secondary to severe trauamatic brain injutry in lactant: a case report.

Introduction: Hypo-pituitarism results from impaired production of one or more of anterior pituitary trophic hormones. Patients with hypo-pituitarism may have isolated pituitary hormone deficiency (IPHD) or multiple pituitary hormone deficiency (MPHD), and may present with varied clinical manifestations like growth failure, central hypothyroidism, or underdeveloped secondary sexual characters. A rare cause of hypo-pituitarism is pituitary stalk transection syndrome.  The Magnetic Ressonance Image (MRI) features of this condition in children and its association with hormonal deficiencies has been reported earlier. Reports on adults with this disorder are scarce, with only one small case series published in the recent literature.

Aim: The aim of this study was to describe the clinico-radiological phenotype of pituitary transection syndrome in a 5 years old girl victim of traumatic brian injury in lactance. 

Materials and Methods: We studied the hormonal deficiency pattern and MRI findings of 1 patient with pituitary stalk transection syndrome who presented to our department with a previous history of severe traumatic brain injury when she was 3 months old.
  
MRI Technique Three millimeter contiguous sagittal and coronal plain through the sella were obtained using a 3.0 T superconducting MRI unit. 

Observations and Results: The child presented with MPHD, with mycrocefphaly, short stature,  and behavioural problems. The MRI features in our case are small anterior pituitary gland, absent or ectopic high signal intensity of posterior pituitary, and absence or hypoplasia of pituitary stalk, besides encephalomalacy on left cerebral hemysphere. 

Discussion: Structural pituitary abnormalities have been reported in 50% 70% of patients with pituitary hormone deficiency. These abnormalities are more prevalent in MPHD. In both adults and children, ectopic posterior pituitary bright spot (EPPBS) at the median eminence was a universal finding in all patients.

Conclusion: This entity should be considered in the differential diagnosis in patients with hypo pituitarism. The presence of MRI features suggestive of pituitary stalk transection syndrome should prompt a full pituitary hormonal evaluation. It is important to closely follow up these patients in the long-term so that their natural history of progressive radiological and hormonal deterioration can be ascertained and these patients can be managed better. As patients progress from IPHD to MPHD, with subsequent hormone deficiencies appearing as they age from childhood to adulthood, the stalk and adenohypophysis become smaller, indicating that the term ‘pituitary stalk hypoplasia’ or ‘thin stalk syndrome’ is more appropriate than pituitary stalk transection syndrome.

Pituitary stalk transection syndrome secondary to severe traumatic brain injury in lactant: a case report.