The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

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, Author, and Disclosure 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
Text Size: A A A

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.


Grahic Jump Location
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.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.