Abstract
Background: The ectopic posterior pituitary (EPP) is a rare condition characterized by the ectopic location of the posterior pituitary lobe associated with varying degrees of stalk anomalies. The arachnoid cysts (AC) are benign lesions of the arachnoid, which account for 1% of all intracranial space-occupying lesions. Sellar/suprasellar ACs account for approximately 1% of all ACs. This is the first case of coexistence EPP with sellar/suprasellar AC.
Case Report: A 67-year-old woman presented with 6 months history of fatigue. Her medical history was positive for irregular menstruation. Her endocrine examinations indicated low free thyroxine level with low TSH level, low oestradiol with low gonadotrophin level, slightly elevated prolactin level. Her Insulin-like growth factor-1 was below the normal levels. Dynamic contrast hypophysis MRI revealed a sellar cystic lesion with a dimension of 18 × 14 × 14 mm, extending from the suprasellar cistern, traversing the diaphragma sellae and reaching the level of the floor of the 3rd ventricle, consistent with sellar/suprasellar AC. There was no wall enhancement. The optic chiasm was compressed. The precontrast T1-weighted magnetic resonance images did not demonstrate the characteristic bright spot of posterior pituitary within the sella, which was higher in position, in the region of the median eminence. The pituitary stalk was not present. Conclusion: Although speculative, we have a hypothesis to explain how the EPP and sellar/- suprasellar AC coexist in this patient. Due to the absence of stalk, CSF may enter the sella tursica from the central aperture of the diaphragma sellae through which normally the stalk passes.Keywords: Hypothalamo-hypophyseal axis, pituitary gland, pituitary stalk, sellar arachnoid cyst, ectopic posterior pituitary, magnetic resonance imaging.
Graphical Abstract
[1]
Lahiri AK, Sundareyan R, Jenkins D, Nilak A. MRI of ectopic posterior pituitary gland with dysgenesis of pituitary stalk in a patient with hypogonadotropic hypogonadism. Radiol Case Rep 2018; 13(4): 764-6.[http://dx.doi.org/10.1016/j.radcr.2018.05.004] [PMID: 29887929]
[2]
Güdük M, HamitAytar M, Sav A, Berkman Z. Intrasellar arachnoid cyst: A case report and review of the literature. Int J Surg Case Rep 2016; 23: 105-8.[http://dx.doi.org/10.1016/j.ijscr.2016.03.033] [PMID: 27107306]
[3]
Mitchell LA, Thomas PQ, Zacharin MR, Scheffer IE. Ectopic posterior pituitary lobe and periventricular heterotopia: cerebral malformations with the same underlying mechanism? AJNR Am J Neuroradiol 2002; 23(9): 1475-81.[PMID: 12372734]
[4]
Jagtap VS, Acharya SV, Sarathi V, et al. Ectopic posterior pituitary and stalk abnormality predicts severity and coexisting hormone deficiencies in patients with congenital growth hormone deficiency. Pituitary 2012; 15(2): 243-50.[http://dx.doi.org/10.1007/s11102-011-0321-4] [PMID: 21667124]
[5]
Dubuisson AS, Stevenaert A, Martin DH, Flandroy PP. Intrasellar arachnoid cysts. Neurosurgery 2007; 61(3): 505-13.[http://dx.doi.org/10.1227/01.NEU.0000290896.69825.40] [PMID: 17881962]
[6]
Delman BN. Imaging of pediatric pituitary abnormalities. Endocrinol Metab Clin North Am 2009; 38(4): 673-98.[http://dx.doi.org/10.1016/j.ecl.2009.09.001] [PMID: 19944287]
[7]
Andrysiak-Mamos E, Sagan K, Sagan L, Sowińska-Przepiera E, Syrenicz A. Cystic lesions of the sellar-suprasellar region - diagnosis and treatment. Endokrynol Pol 2018; 69(2): 212-28.[http://dx.doi.org/10.5603/EP.2018.0023] [PMID: 29952427]
[8]
Chen B, Miao Y, Hu Y, et al. Rare Intrasellar Arachnoid Cyst Distinguishing From Other Benign Cystic Lesions and its Surgical Strategies. J Craniofac Surg 2019; 30(5): e400-2.[http://dx.doi.org/10.1097/SCS.0000000000005315] [PMID: 31299791]
[9]
Ganau M, Talenti G, D’Arco F. Teaching NeuroImages: Radiologic features of septo-optic dysplasia plus syndrome. Neurology 2018; 91(23): e2200-1.[http://dx.doi.org/10.1212/WNL.0000000000006631] [PMID: 30510030]
[10]
Mustansir F, Bashir S, Darbar A. Management of Arachnoid Cysts: A Comprehensive Review. Cureus 2018; 10(4): e2458.[http://dx.doi.org/10.7759/cureus.2458] [PMID: 29888162]
[11]
Ganau M, Ligarotti GK, Apostolopoulos V. Real-time intraoperative ultrasound in brain surgery: neuronavigation and use of contrast-enhanced image fusion. Quant Imaging Med Surg 2019; 9(3): 350-8.[http://dx.doi.org/10.21037/qims.2019.03.06] [PMID: 31032183]
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