PMC4482158_01
Corresponding T1-weighted non-contrast sagittal MRI slices of Patient 1 at baseline (A) and follow-up (B) showed reduction in pituitary size and resolution of suprasellar extension after 3 months of T4. Baseline non-contrast MRI slices demonstrated diffuse pituitary enlargement, suprasellar extension and loss of superior concavity in Patients 2 (C) and 3 (D) on T1-weighted sagittal views, and in Patient 4 on T1-weighted sagittal (E) and T2-weighted coronal views (F).
edmcr-2015-150017-g001.jpg
PMC4482158_02_edmcr-2015-150017-g001.jpg
fig1
MRI brain revealed an enlarged pituitary measuring 13 mm in height with suprasellar extension near the prechiasmatic optic nerves (Fig. 1E and F).
Trans-sphenoidal surgical specimens of Patient 3 demonstrated high gonadotroph concentration on FSH staining at 200x magnification (A) and gonadal-deficiency cells with pale, vacuolated cystoplasm on haematoxylin & eosin staining at 400x magnification (B, arrow). LH staining at 200x magnification (C) revealed the vacuolated cells to be enlarged gonadotrophs with eccentrically displaced nuclei producing a signet-ring appearance in some areas. The gland appeared porous with distended vascular spaces on haematoxylin & eosin staining at 100x magnification (D), possibly reflecting increased vascular demand by the hyperplastic pituitary. There was no acinar enlargement on silver staining for reticulin (not shown). FSH, follicle-stimulating hormone; LH, luteinising hormone.
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PMC4482158_01_edmcr-2015-150017-g002.jpg
fig2
Histopathology demonstrated signs of pathological gonadotroph hyperplasia including gonadal-deficiency cells (Fig. 2).
PMC4482158_02
Corresponding T1-weighted non-contrast sagittal MRI slices of Patient 1 at baseline (A) and follow-up (B) showed reduction in pituitary size and resolution of suprasellar extension after 3 months of T4. Baseline non-contrast MRI slices demonstrated diffuse pituitary enlargement, suprasellar extension and loss of superior concavity in Patients 2 (C) and 3 (D) on T1-weighted sagittal views, and in Patient 4 on T1-weighted sagittal (E) and T2-weighted coronal views (F).
edmcr-2015-150017-g001.jpg
PMC4482158_02_edmcr-2015-150017-g001.jpg
fig1
MRI brain revealed an enlarged pituitary measuring 13 mm in height with suprasellar extension near the prechiasmatic optic nerves (Fig. 1E and F).
PMC4482158_03