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Pituitary Magnetic Resonance Imaging in Normal Human Volunteers: Occult Adenomas in the General Population

Walter A. Hall, MD; Mark G. Luciano, MD, PhD; John L. Doppman, MD; Nicholas J. Patronas, MD; and Edward H. Oldfield, MD
[+] Article and Author Information

From the National Institute of Neurological Disorders and Stroke and The Clinical Center, National Institutes of Health, Bethesda, Maryland. Requests for Reprints: Edward H. Oldfield, MD, Surgical Neurology Branch, Building 10, Room 5D37, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892. Acknowledgments: The authors thank Mrs. Doreen Quimby and Hetty DeVroom, RN, for their contributions and Joseph A. Frank, MD, for his participation in supervising the performance of the magnetic resonance scans.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1994;120(10):817-820. doi:10.7326/0003-4819-120-10-199405150-00001
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Objective: To determine the prevalence of focal lesions of the pituitary gland that suggest the presence of a pituitary adenoma in asymptomatic persons.

Design: 100 normal volunteers (70 women, 30 men; age range, 18 to 60 years old) were studied by high-resolution magnetic resonance imaging (MRI) of the pituitary gland before and after administration of gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA).

Setting: Occult pituitary adenomas are identified at autopsy in 3% to 27% of unselected asymptomatic patients. The frequency of incidental pituitary adenomas detected by MRI in normal persons is unknown.

Measurements: The MRI scans from volunteers were randomly mixed with scans of 57 patients with Cushing disease and interpreted independently by three blinded reviewers.

Results: Seven women (10%) and three men (10%) had focal areas of decreased signal intensity in the pituitary gland after administration of Gd-DTPA. The lesions ranged from 3 to 6 mm in greatest diameter and were diagnosed as pituitary adenomas by at least two of the three reviewers. When similar lesions were detected on MRI scans in patients with Cushing disease, the positive predictive value for identification of an adenoma at that site was 86%.

Conclusions: About 10% of the normal adult population have pituitary abnormalities on MRI scans that are compatible with the diagnosis of asymptomatic pituitary adenomas. Most pituitary adenomas remain asymptomatic and do not require treatment.

Figures

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Figure 1.
Pituitary magnetic resonance scan of a normal volunteer.Left.Right.

T1-weighted (TR-TE:400/12) coronal image before administration of intravenous gadolinium-DTPA shows a sloping sellar floor and an 8 × 4 mm area of low signal intensity on the left side of the pituitary gland compatible with an adenoma. After administration of gadolinium-DTPA, the pituitary gland and stalk enhance homogeneously, and the focal area of low-signal intensity (→) is more clearly seen within the left half of the pituitary gland.

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