Presentation
Central hypothyroidism with decreased anterior pituitary hormone levels. History of transfusion-dependent myelodysplastic syndrome.
Patient Data
T2 images demonstrate markedly reduced signal in the pituitary gland with no discrete lesion seen on the post-contrast images. The normal posterior pituitary bright spot is present.
Case Discussion
Patients who undergo regular blood transfusions are at risk of iron overload. This can affect multiple organs including the heart, liver, pancreas and pituitary gland. Deposition of iron within the pituitary gland can lead to pituitary dysfunction including hypogonadism and hypothyroidism.
On MRI, iron overload is characterized by diffusely reduced T2 and T1 signal, often with volume loss of the gland and with preservation of the normal posterior pituitary bright spot. MRI has also been used to assess for iron overload by measuring R2 values. This has been shown to correlate with serum ferritin levels.
In this case, the patient had iron studies consistent with iron overload, with markedly elevated ferritin, reduced transferrin and increased transferrin saturation. His ferritin level was 6690 μg/L (reference range 45~715 μg/L).
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