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Pediatric Endocrine Imaging: A Case Study

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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

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