Gutenberg et al used a score based on radiologic findings to distinguish a patient with autoimmune hypophysitis from a nonsecreting pituitary adenoma. This can help to distinguish patients who may benefit from medical management from someone who may benefit from surgery. The authors are from University of Gottingen, the University of Pisa, and the Johns Hopkins University.
Patient selection: either autoimmune hypophysitis or nonsecreting pituitary adenoma
Parameters:
(1) age in years
(2) relation to pregnancy
(3) pituitary volume
(4) Gadolinium (Gd) enhancement type
(5) Gadolinium enhancement features
(6) symmetry
(7) posterior pituitary bright spot (normal hyperintensity)
(8) stalk size
(9) thickening of the mucosa in the sphenoid or posterior ethmoid sinuses
|
Parameter |
Finding |
Points |
|
age in years |
<= 30 years |
-1 |
|
|
> 30 years |
0 |
|
relation to pregnancy |
no |
0 |
|
|
yes |
-4 |
|
pituitary volume |
< 6 mL |
0 |
|
|
>= 6 mL |
2 |
|
Gd enhancement type |
low |
0 |
|
|
medium or high |
-1 |
|
Gd enhancement features |
homogeneous or centrally hypointense |
0 |
|
|
heterogeneous |
1 |
|
symmetry |
symmetrical |
0 |
|
|
asymmetrical |
3 |
|
posterior pituitary bright spot |
present |
0 |
|
|
absent (lost) |
-2 |
|
stalk size |
normal |
0 |
|
|
enlarged |
-5 |
|
mucosal thickening |
absent |
0 |
|
|
present |
2 |
radiologic score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: -13
• maximum score: 8
• The higher the score the more likely that the patient has a nonfunctioning pituitary adenoma.
• A score >= 1 had the maximum Youden index (sensitivity 92%, specificity 99%).
• According to Figure 3, a score < -2 was only seen with autoimmune hypophysitis and a score > 2 was only seen with a pituitary adenoma, with some overlap in between.
Specialty: Endocrinology, Clinical Laboratory, Neurology, Immunology/Rheumatology
ICD-10: ,
