Diagnosis: HypopituitarismClinical question: hypogonadotropic hypogonadismSigns and Symptoms: decreased libido MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a small periventricular white matter lesion present adjacent to the left lateral ventricle. It is high signal on FLAIR and T2 imaging. In isolation it is likely of little clinical significance.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The left Meckel's cave appears asymmetrically larger than the right Meckel's cave. No particular lesion is identified in the Meckel's cave.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The left vertebral artery is very small. The right transverse sinus is larger than the left transverse sinus.The visualized portions of the paranasal sinuses demonstrate minimal mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI pituitary:The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. The cavernous sinuses are intact bilaterally. There is an ill-defined focus of T1 signal hyperintensity present within the right half of the pituitary gland measuring approximately 4 mm in size which is associated with some hyperenhancement on the postcontrast images and on the dynamic sequence.
1.There is a ill-defined lesion in the right half of the pituitary gland which is nonspecific. It does not appear to be typical of an adenoma. It is possible this represents some local hypervascularity or blood products but is unclear what it represents.2.There is a small periventricular white matter lesion present adjacent to the left lateral ventricle. In isolation it is likely of little clinical significance.