Differential diagnosis of pediatric pituitary gland lesions

• Pituitary interrupted stalk syndrome
• Ectopic posterior pituitary
• Langerhans cell histiocytosis of pituitary
• Rathke cleft cyst
• Pituitary microadenoma
• Pituitary macroadenoma
• Craniopharyngioma

Approach to the differential diagnosis of pituitary gland lesions:

• In pituitary interrupted stalk syndrome the pituitary gland is in the sella but the pituitary stalk cannot be visualized
• In ectopic posterior pituitary the high signal intensity posterior portion of the pituitary gland is absent from the sella and is usually in the hypothalamus
• Langerhans cell histiocytosis of pituitary causes focal thickening of the pituitary stalk
• Rathke cleft cyst is a simple cystic non-enhancing lesion located between the anterior and posterior aspects of the pituitary gland
• Pituitary microadenoma is a small solid lesion in the pituitary gland that enhances less than the surrounding pituitary tissue
• Pituitary macroadenoma is a large solid homogeneously enhancing lesion arising in the sella which often extends superiorly
• Craniopharyngioma is a large cystic and solid heterogeneously enhancing lesion arising in the sella which often extends superiorly