ABSTRACT
The pituitary gland is a small but physiologically highly complex structure located at the center of the endocrine system. Owing to its direct connection with the hypothalamus, it is responsible for regulating multiple hormonal axes. Therefore, pituitary disorders can manifest across a wide clinical spectrum with various endocrine dysfunctions. Accurate identification and characterization of pituitary pathologies are of critical importance for directing patients toward appropriate medical or surgical treatment. Today, magnetic resonance imaging (MRI) is recognized as the primary method for evaluating the pituitary gland. With its high tissue resolution, multiplanar imaging capability, and dynamic contrast-enhanced sequences, MRI has become an indispensable tool for revealing both anatomical details and functional alterations. This review discusses the radiological assessment of the pituitary gland in the context of endocrine diseases, common pathologies, and emerging imaging approaches.
Keywords:
Pituitary gland, endocrine diseases, magnetic resonance imaging, pituitary adenoma, hypopituitarism
References
1
Giraldi E, Allen JW, Ioachimescu AG. Pituitary Incidentalomas: best practices and looking ahead. Endocr Pract. 2023; 29: 60-68.
2
Standring S. Chapter 28: Intracranial region , in Gray’s anatomy: the anatomical basis of clinical practice. 2016, Elsevier: New York. p. 431-432.
3
Schuenke M, Schulte E, Schumacher U, Stefan C. Thieme atlas of anatomy. Head, neck, and neuroanatomy. In: Georg Thieme Verlag, editors. 4th ed. New York: Thieme; 2025.p.1.
4
Kahle W, Leonhardt H , Platzer W. Color atlas of human anatomy: locomotor system. 7th ed. In G. Thieme Verlag ed. New York: Thieme; 2015.
5
Ryan S, McNicholas M, Eustace S. Anatomy for diagnostic imaging. 3rd ed. Saunders/Elsevier: New York; 2011.p.337.
6
Tsunoda A, Okuda O, Sato K. MR height of the pituitary gland as a function of age and sex: especially physiological hypertrophy in adolescence and in climacterium. AJNR Am J Neuroradiol. 1997; 18: 551-4.
7
Yadav P, Singhal S, Chauhan S, Harit S. MRI evaluation of size and shape of normal pituitary gland: age and sex related changes. JCDR. 2017; 11.
8
Chapman PR, Singhal A, Gaddamanugu S, Prattipati V. Neuroimaging of the pituitary gland: practical anatomy and pathology. Radiol Clin North Am. 2020; 58: 1115-33.
9
Osborn, GA, Hedlund GL, Salzman KL. Osborn’s brain : imaging, pathology, and anatomy. 2nd ed. In Philadelphia, PA : Elsevier. United States; 2018.
10
Kanal E, Maravilla K, Rowley HA. Gadolinium contrast agents for CNS imaging: current concepts and clinical evidence. AJNR Am J Neuroradiol. 2014; 35: 2215-26.
11
Chaudhary V, Bano S. Imaging of the pituitary: recent advances. Indian J Endocrinol Metab. 2011; 15 Suppl 3: S216-23.
12
Grajo JR, Paspulati RM, Sahani DV, Kambadakone A. Multiple endocrine neoplasia syndromes: a comprehensive imaging review. Radiol Clin North Am. 2016; 54: 441-51.
13
Bonneville JF, Bonneville F, Cattin F. Magnetic resonance imaging of pituitary adenomas. Eur Radiol. 2005; 15: 543-8.
14
Elster AD. High-resolution, dynamic pituitary MR imaging: standard of care or academic pastime? AJR Am J Roentgenol. 1994; 163: 680-2.
15
Elster AD. Modern imaging of the pituitary. Radiology. 1993; 187: 1-14.
16
Ezzat S, Asa SL, Couldwell WT, Barr CE, Dodge WE, Vance ML, et al. The prevalence of pituitary adenomas: a systematic review. Cancer. 2004; 101: 613-9.
17
Schaller B. Gender-related differences in prolactinomas. A clinicopathological study. Neuro Endocrinol Lett. 2005; 26: 152-9. Erratum in: Neuro Endocrinol Lett. 2005; 26: 628.
18
Bayrak A, Saadat P, Mor E, Chong L, Paulson RJ, Sokol RZ. Pituitary imaging is indicated for the evaluation of hyperprolactinemia. Fertil Steril. 2005; 84: 181-5.
19
Fujimura M, Ikeda H, Takahashi A, Ezura M, Yoshimoto T, Tominaga T. Diagnostic value of super-selective bilateral cavernous sinus sampling with hypothalamic stimulating hormone loading in patients with ACTH-producing pituitary adenoma. Neurol Res. 2005; 27: 11-5.
20
Liu C, Lo JC, Dowd CF, Wilson CB, Kunwar S, Aron DC, et al. Cavernous and inferior petrosal sinus sampling in the evaluation of ACTH-dependent Cushing’s syndrome. Clin Endocrinol (Oxf). 2004; 61: 478-86.
21
Bourdelot A, Coste J, Hazebroucq V, Gaillard S, Cazabat L, Bertagna X, et al. Clinical, hormonal and magnetic resonance imaging (MRI) predictors of transsphenoidal surgery outcome in acromegaly. Eur J Endocrinol. 2004; 150: 763-71.
22
Besser GM, Burman P, Daly AF. Predictors and rates of treatment-resistant tumor growth in acromegaly. Eur J Endocrinol. 2005; 153: 187-93.
23
Sarlis NJ, Gourgiotis L, Koch CA, Skarulis MC, Brucker-Davis F, Doppman JL, et al. MR imaging features of thyrotropin-secreting pituitary adenomas at initial presentation. AJR Am J Roentgenol. 2003; 181: 577-82.
24
Knosp E, Steiner E, Kitz K, Matula C. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery. 1993; 33: 610-7; discussion 617-8.
25
Ostrov SG, Quencer RM, Hoffman JC, Davis PC, Hasso AN, David NJ. Hemorrhage within pituitary adenomas: how often associated with pituitary apoplexy syndrome ? AJR Am J Roentgenol. 1989; 153: 153-60.
26
Arita K, Kurisu K, Tominaga A, Sugiyama K, Ikawa F, Yoshioka H, et al. Thickening of sphenoid sinus mucosa during the acute stage of pituitary apoplexy. J Neurosurg. 2001; 95: 897-901.
27
Rogg JM, Tung GA, Anderson G, Cortez S. Pituitary apoplexy: early detection with diffusion-weighted MR imaging. AJNR Am J Neuroradiol. 2002; 23: 1240-5.
28
Byun WM, Kim OL, Kim D. MR imaging findings of Rathke’s cleft cysts: significance of intracystic nodules. AJNR Am J Neuroradiol. 2000; 21: 485-8.
29
Fassett DR, Couldwell WT. Metastases to the pituitary gland. Neurosurg Focus. 2004; 16: E8.
30
Higham CE, Olsson-Brown A, Carroll P, Cooksley T, Larkin J, Lorigan P, et al. Society For Endocrinology Endocrine Emergency Guidance: acute management of the endocrine complications of checkpoint inhibitor therapy. Endocr Connect. 2018; 7: G1-7.
31
Saiwai S, Inoue Y, Ishihara T, Matsumoto S, Nemoto Y, Tashiro T, et al. Lymphocytic adenohypophysitis: skull radiographs and MRI. Neuroradiology. 1998; 40: 114-20.
