Pediatric Endocrine Imaging – Evaluation of the pituitary gland and a child with precocious puberty. Dr Priscilla Joshi Major Endocrine glands, which may need evaluation in children, are • Pituitary : hypophysis- hypothalamus axis • Thyroid • Parathyroid • Pancreas • Adrenals • Gonads- ovaries and testes This chapter would deal predominantly with imaging of the pituitary gland as well as evaluating a child with precocious puberty. The armamentarium of radiological investigations available to assess the structure of these organs in a patient with endocrine dysfunction are A) Conventional radiography B) Ultrasonography C) CT scan F) MRI The radiological investigations to assess function include: A) Radionuclide imaging (Scintigraphy) …show more content…
Stalk thickness >2.6 mm is suggestive of pathological infiltration. It shows intense post gadolinium enhancement due to lack of blood brain barrier. It should taper smoothly from largest portion at tuber cinereum to smallest portion at insertion into the neurohypophysis. Abrupt change in size should raise suspicion of a mass The normal pituitary volume The normal volume of the gland is age related . The height of the pituitary gland varies as follows : 4.5 +/- 2 at <6 weeks gestation to 4.5+/- 0.6 mm at 5-10 years 5 +/-2 in boys 10-20 years of age 8+/-2 in girls 10-20 years of age Volume of the pituitary gland, including the posterior pituitary ranges from 174+/- 118 cmm at 6 weeks to 2 years 184 to 214 +/- 145 cmm at 2 – 5 years 226 to 277 cmm +/- 188 at 5-10 years Pituitary Dysfunction Diabetes Insipidus This occurs due to dysfunction of the paraventricular or supraoptic nuclei of the hypothalamus. Despite infiltration of the nuclei the infundibulum may appear normal in size. Imaging of the hypothalamic region excludes a hypothalamic/infundibular mass. Imaging may reveal subtle findings or maybe normal at the time of initial
Next, they traced the external jugular vein and its tributary veins on the surface of the right side of the neck and head. On the left side where the sternomastoid was cut, the students then located the deeper vessels running alongside the trachea, internal jugular vein, and the common carotid artery. In the abdominal cavity, the groups then exposed and studied the hepatic portal vein and its tributaries. They then identified the tributaries of the post cava, the renal, adrenolumbar, iliolumbar, iliac, and caudal vessels. The arteries of the gonads then came off the abdominal aorta cranial where the spermatic arteries were found.
After a few years, there was a tumor in her pituitary region. The tumor was secreting excessive amounts of growth hormone, casing symptoms to appear. She had enlarged hands and feet, coarsened, enlarged facial features, coarse, oily, thickened skin, and
The secretion of cortisol is controlled by the hypothalamic-pituitary-adrenal axis, which is a three inter-communicating regions of the body, the hypothalamus in the brain, the pituitary gland and the adrenal gland. When cortisol levels in the blood are reduced, a collection of cells in the hypothalamus release corticotrophin-releasing hormone, which causes the
This could cause dysplasia of the anterior pituitary leading to the growth of a tumor (Greco, 2013, Lecture). Because he is not growing facial hair the doctors know that he is not at risk for producing too much hormone and developing a
When chowing down on some delicious cat food, Mr. Kibbles, do to his old age suffered from a stroke. Which ended up having long lasting effects on his overall endocrine system. Although your friend Betty is very happy that Mr. Kibbles survived his stroke, she is still confused on what extent his endocrine system has been compromised. She has called on you, her trusty physiologist best friend to thoroughly explain exactly what is going on within Mr. Kibbles. Although the vet did give a basic outline of what is wrong with Mr. Kibbles, he did not use specifics.
An unbalance in these hormones would cause changes in the function and structure of the gland. In the setting where there isn’t a sufficient amount of Thyroxin synthesized by the gland, there is an increase in TSH production. Over production of TSH causes hyperplasia of the gland just to match normal thyroid levels. This would then cause a goiter to form. When the goiter is grown significantly, pressure is put on the esophagus and trachea, causing respiratory
CASE: John Smith is an 11 year old Asian boy with PMHx of hypothyroidism x 2 years, on levothyroxine 25 mcg daily presented with painful progressively enlarging goiter that started 2 months ago. The pain is described as constant shooting and radiating to the neck, rated 6/10, nothing made it better, moving his neck made it worse. Pt states that the pain is mostly localized to the right, and it is associated with compressive symptoms like difficulty breathing and swallowing, but no change in voice. The swelling was painful and progressive and at the time of examination was 2 × 2 cm on the right side of the neck and was moving with deglutition. She had no other complaints and her family history was noncontributory.
Many people who suffer from a deficiency of thyroid hormone experience the discomfort and dis-ease this produces for years before seeking help. In diagnoses, doctors tend to stick with serum tests to check for the presence of thyroid hormone in the blood. Frequently, this returns an answer that misses the underlying condition. A more accurate test checks for the intracellular activity of calcium, magnesium and potassium.
The pituitary is a small gland found inside the skull just below the brain and above the nasal passages, which are above the fleshy back part of the roof of the mouth (known as the soft palate). The pituitary sits in a tiny bony space called the sella turcica. The nerves that connect the eyes to the brain, called the optic nerves, pass close by it. Is a small neuro-endocrine organ with a diameter of only 1 centimetre,
This can be illustrated over a period of time. Once an individual can see the progressive change in the organ’s function. For instance, an ultrasound Doppler can illustrate normal blood flow and impeded blood flow in the heart. Also, brain scans use functional imaging. A patient’s brain lights up in a scan when he/she answers yes/no questions or executes cognitive tasks such as counting or recognizing objects.
On either side are openings of sphenoidal air sinuses and sphenoidal concha. Posterior surface fuses with basilar part of occipital bone by 25th year . (
Imaging of malignancies shows invasion of the adjacent structures (nerves, bone, skull base, meninges and adjacent cervical spaces) and capsule rapture in pleomorphic adenoma all of them are better viewed by MRI. Postgadolinium, fat-supporetd T1W images are preferred for determining the invasions. Malignancies are also characterized by ill-defined margins in post contrast images.
(1962). Hypophysectomized immature female rats,80-100 gm weight were used in this study. 20µ of purified ACTH (Porcine-ACTH, Sigma Chemical Co., USA) dissolved in 0.5ml of physiological saline was administered to rats in a single dose by sub-cutaneous injection. The control group received physiological saline (0.9%) only which was administered to rats in a single dose by sub-cutaneous injection. Rats were sacrificed at different periods by cervical dislocation, dissected and the adrenals free of adhering fat were used for analysis.
These glands together make up what is known as the endocrine system, whose control and command centers are the pituitary gland and hypothalamus. Other endocrine glands are the endocrine pancreas, pineal, adrenal, thyroid and parathyroid glands. Specialists who conduct surgery on these glands are called endocrine surgeons. Hypothalamus and pituitary gland Hamartomas, although rare, are non-neoplastic tumors that arise in the hypothalamus and cause devastating consequences, such as seizures, cognitive impairment, behavioral and emotional troubles, hormonal imbalances and early puberty.
Caffey J. Infantile cortical hyperostosis; a review of the clinical and radiographic features. Proc R Soc Med 1957;50:347-54. 8. Kaufmann HJ, Mahboubi S, Mandell GA. Case report 39.