Pituitary stalk interruption syndrome, also known as pituitary stalk transection syndrome, is a syndrome characterized by an absent or hypoplastic anterior pituitary gland, thin or absent infundibulum, and ectopic posterior pituitary location.
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Epidemiology
Pituitary stalk interruption syndrome is very rare with an estimated incidence of 0.5 in 100,000 births 5.
Clinical presentation
Patients with pituitary stalk interruption usually present in the first decade of life with deficiency of growth hormones resulting in growth restriction 1. What can initially present as isolated growth hormone deficiency may progress to multiple pituitary hormones deficiencies with the eventual development of panhypopituitarism with preservation of posterior pituitary function 2,4.
The combination of hyperprolactinemia and hypothyroidism is known as Pickardt syndrome 4.
In addition to endocrinological manifestations, there appears to be an increased incidence of breech presentation and difficult delivery 4. A number of additional features may be encountered later in childhood including learning difficulties and seizures 4.
Pathology
Various hypotheses have been proposed to explain the syndrome such as defective migration of the pituitary gland during intrauterine life or ischemia with subsequent reorganization of the infundibular axons and development of an ectopic posterior pituitary 1.
Radiographic features
MRI
MRI is required for the diagnosis and demonstrates 4:
absent/hypoplastic anterior pituitary gland
thin or absent infundibulum
Treatment and prognosis
Treatment consists of hormonal replacement 3.