Clinical question: Evaluate pituitary gland given the concern for hypopituitarism. Signs and symptoms: Low cortisol level there Pre-and post-enhanced pituitary MRI:The pituitary gland is uniformly small in size and measuring approximately at 1.7-mm in height. There is a tiny cyst like lesion along the superior aspect of pituitary on the left without enhancement and measuring approximately 2 mm in size. This finding is best appreciated on coronal T2 weighted series on image 14.Pituitary stalk is in midline and demonstrate normal expected enhancement. The caliber of pituitary stalk however appears also small. There is no detectable abnormal signal morphology or enhancement of the hypothalamic region.Bilateral cavernous sinuses are unremarkable.Pre-and post-enhanced brain MRI:Unremarkable diffusion weighted images.Examination demonstrate mild periventricular foci of flair hyperintensity which considering patient's stated age likely representing chronic small vessel ischemic strokes. Slight prominence of cortical sulci and ventricular system likely within normal range for age. The signal void of major intracranial arterial branches are identified. There is no detectable abnormal parenchymal or leptomeningeal enhancement.Mild sinus disease and unremarkable orbits.
1.MRI of pituitary demonstrated uniformly smaller size of pituitary gland and measuring maximum of 1.7-mm in height. It is uncertain what this morphology is pathologic for patient's stated age of 78. Pituitary stalk is in midline and the suggestion of decreased caliber however with expected enhancement. Suspected two minute nonenhancing cyst as detailed.2.Pre-and post-enhanced brain MRI demonstrate no acute intracranial process. Findings suggestive of mild chronic non-hemorrhagic small vessel ischemic strokes and unremarkable otherwise.