Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Pituitary
Published in: Pituitary 6/2016

01-12-2016

Prediction of postoperative diabetes insipidus using morphological hyperintensity patterns in the pituitary stalk on magnetic resonance imaging after transsphenoidal surgery for sellar tumors

Authors: Yasuhiko Hayashi, Daisuke Kita, Takuya Watanabe, Issei Fukui, Yasuo Sasagawa, Masahiro Oishi, Osamu Tachibana, Fumiaki Ueda, Mitsutoshi Nakada

Published in: Pituitary | Issue 6/2016

Login to get access

Abstract

Purpose

Diabetes insipidus (DI) remains a complication of transsphenoidal surgery (TSS) for sellar and parasellar tumors. Antidiuretic hormone (ADH) appears as hyper intensity (HI) in the pituitary stalk and the posterior lobe of the pituitary gland on T1-weighted magnetic resonance (MR) imaging. Its disappearance from the posterior lobe occurs with DI, indicating a lack of ADH. The appearance of HI in the pituitary stalk indicates disturbances in ADH transport.

Methods

This retrospective study included 172 patients undergoing TSS for sellar tumors at our institute from 2006 to 2014. Sequential T1-weighted MR images without enhancement were evaluated for HI in the pituitary stalk and the posterior lobe to assess the localization of ADH before and at intervals after TSS. DI was assessed pre- and postoperatively. HI in the pituitary stalk showed the following morphology: (1) ovoid in the distal end of the pituitary stalk (group A), (2) linear in the distal part of the pituitary stalk (group B), (3) linear in the whole pituitary stalk (group C).

Results

Preoperative DI occurred in 6 patients (3.5 %) with no HI observed in the posterior lobe. Postoperative DI was transient in 82 patients (47.7 %), and permanent in 11 (6.4 %). One week after surgery, HI was absent in the posterior lobe in 74 patients (43.0 %), and present in the pituitary stalk in 99 patients (57.6 %); both were significantly correlated with postoperative DI (p < 0.001). The absence of HI in the posterior lobe (A, 48.9 %; B, 68.3 %; C, 92.3 %), persistence of DI (A, 3.7 days; B, 45.9 days; C, 20.5 months), and duration until HI recovery in the posterior lobe (A, 3.6 months; B, 6.8 months; C, 22.9 months) were greatest in group C, followed by group B, and then group A. Fourteen group A patients did not have postoperative DI despite having HI in the pituitary stalk and the posterior lobe. Four group C patients developed permanent DI with persistence HI in the pituitary stalk.

Conclusion

HI in the pituitary stalk and its absence in the posterior lobe indicated postoperative DI, which was transient if HI was detected in the pituitary stalk. DI duration could be predicted by the length of HI in the pituitary stalk, which corresponded to the degree of ADH transport obstruction.
Literature
1.
2.
Naldich MJ, Russel EJ (1993) Current approaches to imaging of the sellar region and pituitary. Endocrinol Metab Clin N Am 28:45–79CrossRef
3.
Zucchint S, di Natale B, Ambrosetto P, De Angelis R, Cacciari E, Chiumello G (1995) Role of magnetic resonance imaging in hypothalamic pituitary disorders. Horm Res 44:8–14CrossRef
4.
Fujisawa I (2004) Magnetic resonance imaging of the hypothalamic-neurohypophyseal system. J Neuroendocrinol 16:297–302CrossRefPubMed
5.
Holder CA, Elster AD (1997) Magnetization transfer imaging of the pituitary: further insights into the nature of the posterior “bright spot”. J Comput Assist Tomogr 21:71–74CrossRef
6.
Kurokawa H, Fujisawa I, Nakano Y, Kimura H, Akagi K, Ikeda K, Uokawa K, Tanaka Y (1998) Posterior lobe of the pituitary gland: correlation between signal intensity on T1-weighted MR images and vasopressin concentration. Radiology 207:79–83CrossRefPubMed
7.
Fujisawa I, Kikuchi K, Nishimura K (1987) Transection of the pituitary stalk: development of an ectopic posterior lobe assessed with MR imaging. Radiology 165:487–489CrossRefPubMed
8.
Colombo N, Belly I, Kucharczyk J, Berry I, Kucharczyk J, Kucharczyk W, de Groot J, Larson T, Norman D, Newton TH (1987) Posterior pituitary gland: appearance on MR images in normal and pathologic states. Radiology 81:481–485CrossRef
9.
Tien R, Kucharczyk J, Kucharczyk W (1991) MR imaging of the brain in patients with diabetes insipidus. AJNR 12:533–542PubMed
10.
Yamamoto T, Ishii T, Yoshioka K, Yamagami K, Yamakita T, Miyamoto M, Hosoi M, Sato T, Tanaka S, Fujii S (2003) Transient central diabetes insipidus in pregnancy with a peculiar change in signal intensity on T1-weighted magnetic resonance images. Intern Med 42:513–516CrossRefPubMed
11.
Saeki N, Tokunaga H, Wagai N, Sunami K, Murai H, Kubota M, Tatsuno I, Saito Y, Yamaura A (2003) MRI of ectopic posterior pituitary bright spot with large adenomas: appearances and relationship to transient postoperative diabetes insipidus. Neuroradiology 45:713–716CrossRefPubMed
12.
Hayashi Y, Oishi M, Kita D, Tachibana T, Hamada J (2015) Pure Lymphocytic infundibuloneurohypophysitis caused by the rupture of Rathke’s Cleft Cyst: report of 2 cases and review of the literature. Turk Neurosurg 25:332–336. doi:10.​5137/​1019-5149 PubMed
13.
Fujisawa I, Nishimura K, Asato R, Togashi K, Itoh K, Noma S, Kuwamura Y, Sago T, Nakano Y, Ito H, Torizuka K (1987) Posterior lobe of the pituitary in diabetes insipidus: MR findings. J Comput Assist Tomogr 11:221–225CrossRefPubMed
14.
Saeki N, Hoshi S, Sunada S, Sunami K, Murai H, Kubota M, Tatsuno I, Iuchi T, Yamaura A (2002) Correlation of high signal intensity of the pituitary stalk in macroadenoma and postoperative diabetes insipidus. AJNR 23:822–827PubMed
15.
Hensen J, Henig A, Fuhlbusch R, Meyer M, Boehnert M, Buchfelder M (1999) Prevalence, predictors and patterns of postoperative polyuria and hyponatremia in the immediate course after transsphenoidal surgery for pituitary adenomas. Clin Endocrinol 50:431–439CrossRef
16.
Ciric I, Ragin A, Baumgartner C, Pierce D (1997) Complications of transsphenoidal surgery; results of a national survey, review of the literature and personal experience. Neurosurgery 40:225–237CrossRefPubMed
17.
Brooks BS, Gamma TE, Adison JO, Hoffman WH (1989) Frequency and variation of the posterior pituitary bright signal on MR images. AJNR 10:943–948PubMed
18.
Brooks BS, El Gammal T, Allison JD, Hoffman WH (1989) Frequency and variation of the posterior pituitary bright signal on MR images. AJR Am J Roentgenol 153:1033–1038CrossRefPubMed
19.
Terano T, Sey A, Tamura Y, Yoshida S, Hirayama T (1996) Characteristics of the pituitary gland in elderly subjects from magnetic resonance images: relationship in pituitary hormone secretion. Clin Endocrinol 45:273–279CrossRef
20.
Saeki N, Hayasaka M, Murai H, Kubota M, Tatsuno I, Takanashi J, Uno T, Iuchi T, Yamaura A (2003) Posterior pituitary bright spot in large adenomas: MR assessment of its disappearance or relocation along the stalk. Radiology 226:359–365CrossRefPubMed
21.
Sato N, Ishizuka H, Yagi H, Matsumoto M, Endo K (1993) Posterior lobe of the pituitary in diabetes insipidus: dynamic MR imaging. Radiology 186:357–360CrossRefPubMed
22.
Reeves WB, Bichet DG, Andreoli TE (1998) Posterior pituitary and water metabolism. In: Wilson JD, Foster DW, Kronenberg HM, Larsen PR (eds) Williams textbook of endocrinology, 9th edn. W. B. Saunders, Philadelphia, pp 341–387
23.
Fujisawa I, Asato R, Kuwata M, Sano Y, Nakao K, Tamada T, Imura H, Naito Y, Hoshino K, Noma S, Nakano Y, Konishi J (1989) Hyperintense signal of the posterior pituitary on T1-weighted MR images: an experimental study. J Comput Assist Tomogr 13:371–377CrossRefPubMed
24.
Fitzsimmons MD, Roberts MM, Sherman TG, Robinson AG (1992) Models of neurohypophyseal homeostasis. Am J Physiol 262:R1121–R1130PubMed
25.
Lederis K, Jayasena K (1970) Storage of neurohypophyseal hormones and the mechanism for their release. In: Heller H, Pickering BD (eds) Pharmacology of the endocrine system and release drugs: the neurohypophysis, 28th edn. Pergamon Press, London, pp 111–154
26.
Billenstein DC, Leveque TF (1955) Reorganization of the neurohypophysectomy in the rat. Endocrinology 56:704–707CrossRef
27.
Gamma TE, Brooks BS, Hoffman WH (1989) MR imaging of the ectopic bright signal of posterior pituitary regeneration. AJNR 10:323–328
28.
Reichkin S (1981) Neuroendocrinology. In: Williams RH (ed) Textbook of endocrinology, 6th edn. WB Saunders, Philadelphia, pp 589–654
29.
Thomsen E (1955) Studies on the transport of neurosecretary materials in Calliphora erythrocephala by means of ligation experiments. J Exp Biol 31:322–333
30.
Fujisawa I, Uokawa K, Horii N, Murakami N, Azuma N, Furuto-Kato S, Yamashita K, Nakao S, Kageyama N (2002) Bright pituitary stalk on MR T1-weighted image: damming up phenomenon of the neurosecretary granules. Endocr J 49:165–173CrossRefPubMed
Metadata
Title
Prediction of postoperative diabetes insipidus using morphological hyperintensity patterns in the pituitary stalk on magnetic resonance imaging after transsphenoidal surgery for sellar tumors
Authors
Yasuhiko Hayashi
Daisuke Kita
Takuya Watanabe
Issei Fukui
Yasuo Sasagawa
Masahiro Oishi
Osamu Tachibana
Fumiaki Ueda
Mitsutoshi Nakada
Publication date
01-12-2016
Publisher
Springer US
Published in
Pituitary / Issue 6/2016
Print ISSN: 1386-341X
Electronic ISSN: 1573-7403
DOI
https://doi.org/10.1007/s11102-016-0739-9

Other articles of this Issue 6/2016

Pituitary 6/2016 Go to the issue

OriginalPaper

Low frequency of cardniac arrhythmias and lack of structural heart disease in medically-naïve acromegaly patients: a prospective study at baseline and after 1 year of somatostatin analogs treatment

OriginalPaper

Sex differences in the prevalence of metabolic syndrome and its components in hypopituitary patients: comparison with an age- and sex-matched nationwide control group

OriginalPaper

Long-term outcomes of children treated for Cushing’s disease: a single center experience

OriginalPaper

Pituitary tumors in MEN1: do not be misled by borderline elevated prolactin levels

OriginalPaper

Paradoxical and atypical responses to pasireotide in aggressive ACTH-secreting pituitary tumors

OriginalPaper

Incidence and risk factors of subdural hematoma after intraoperative cerebrospinal fluid leakage during the transsphenoidal approach

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits