Magnetic Resonance Imaging of Pituitary Morphology in Idiopathic Intracranial Hypertension among Egyptian Population

Purpose: Intracranial hypertension can change the morphology of anatomical structures that are critical in the evaluation of pseudotumor syndromes. The aim of this study was to investigate the morphologic changes of the pituitary gland using magnetic resonance imaging (MRI) in patients with the clinical diagnosis of idiopathic intracranial hypertension (IIH) also known as pseudotumor cerebri. Idiopathic intracranial hypertension is a syndrome characterized by increased intracranial pressure and papilledema in patients without focal neurologic findings, except for an occasional sixth nerve palsy.Materials and Methods: Forty patients with confirmed IIH using Modified Dandy Criteria and 20 controls were evaluated with brain MRI for the analyses of pituitary morphology. The majority of our patients were women ranging in age from 25 to 51 years. The pituitary height (concavity) was classified on the sagittal T1-weighted image in MRI into five categories: 1= normal, 11= superior concavity that was mild ( 1/3) the height of the sella), 111= moderate (between (1/3) and (2/3) concavity of height of sella), IV= severe ( 2/3) concavity of height of sella) and V= empty sella.Results: Using moderate concavity ( 1/3) as the minimum criterion for abnormality, IIH patients had an 85% incidence of morphologic changes. A posterior deviation of the pituitary stalk was seen in 30% of patients. The measurements were greater than the size of the normal pituitary gland in the controls. Empty sella (almost complete concavity of the sella) was found in 10 patients with IIH.Conclusion: Routine brain MR examination of patients with IIH frequently shows morphologic changes of the pituitary gland ranging from various degrees of concavity to the extreme case of an empty sella. Such results may be useful to assist the diagnosis of IIH, particularly in patients with equivocal clinical findings or when IIH is not suspected.