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Joseph Junewick, MD FACR
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Thickened Pituitary Stalk

Case Detail

Anatomy: Brain-Spine
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 10 years ago
Updated: over 9 years ago
Tags: PEDS
Modality/Study Types: MR
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17 year old female with polyendocrinopathy.

Case Images


Thickened Pituitary Stalk


MR – Sagittal T2 and sagittal and coronal post-gadolinium T1 images of the sella tursica demonstrate bulbous enlargement and enhancement of the pituitary stalk.


The normal pituitary stalk is widest superiorly and tapers inferiorly, measuring 3.5 mm near the median eminence, 2.88 mm at its midpoint, and 1.9 mm at its insertion into the pituitary gland. The pituitary stalk is isointense relative to the optic chiasm on T1 and T2 weighted images and intensely enhances with intravenous gadolinium (absent blood-brain barrier). Deviation or tilt of the pituitary stalk can be normal. Enlargement of the pituitary stalk greater than 2–3 mm on MRI is abnormal. Pathologic thickening is fairly evenly divided among tumor and tumor-like lesions (e.g., Langerhans cell histiocytosis, germ cell tumor, glioma and metastasis), infectious and inflammatory conditions (e.g., lymphocytic infundibuloneurohypophysitis, Wegener’s granulomatosis, sarcoidosis, tuberculosis) and congenital etiologies (e.g., duplication, pituitary hypoplasia, ectopic posterior pituitary).


Rupp D, Molitch M. Pituitary stalk lesions. Current Opinion in Endocrinology, Diabetes & Obesity 2008, 15:339–345.

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