The report, which was very technical and difficult to use for dissemination purposes, focused on the complex interaction in the diagnostic and follow-up (post medical or surgical therapy) phases.
The endocrine pathologies that involve the neuroradiologist (a highly specialized figure on brain diagnostics, which should not be entrusted to the general radiologist, precisely because it is very specific) are predominantly pituitary-secreting ones. In non-secreting forms, the endocrinologist is usually contacted AFTER surgery or for diagnostic completeness, by another specialist, and the neuroradiologist has certainly already intervened.
The most frequent pituitary pathology is Hyperprolactinemia (pituitary adenoma, a pathology ALWAYS benign, accounts for 44% of pituitary tumors) with a prevalence around 60-100/million and an incidence of 6-10/million per year. As if to say that in a city like Rome, about 36-60 people a year get pituitary adenoma. the role of the neuroradiologist is crucial to distinguish a stress hyperprolactinemia or adenoma, and to evaluate the effectiveness of therapy (usually medical).
As frequency it follows Cushing’s disease (incidence 5-25/million/year), which consists of increased cortisol levels due to ACTH-secreting pituitary adenoma. The endocrinologist usually has the laboratory and clinical diagnostic tools to detect increased cortisol levels, but the role of the neuroradiologist is critical to localize the pathology and to define whether cortisol secretion is autonomous or dependent on pituitary adenoma, and to decide whether to refer to the neurosurgeon or proceed with medical therapy.
The neuroradiologist can participate directly with interventional procedures such as petrous sinus catheterization, which measures ACTH levels directly in the pituitary circulation, and correlates with peripheral circulating ACTH levels.
Acromegaly and gigantism are an additional cause for referral to the neuroradiologist by the endocrinologist. These are rare disorders with an incidence of 3/million, but known to the general public because patients have distinctive physiognomic features, and some patients with acromegaly have been well known in the past (such as Primo Carnera, the great boxer of the twentieth century).
Rare but existing, TSH-oma, a cause of hyperthyroidism of pituitary origin (accounts for less than 1% of functioning pituitary tumors and is the cause of 0.1% of cases of hyperthyroidism).
The extra-hypophyseal pathology that involves the neuroradiologist is definitely Basedowian ophthalmopathy, which is the typical ocular involvement of Basedow’s disease hyperthyroidism, that from the presence of TSH receptor antibody. Evaluation of the level of involvement of the retrobulbar fat or the extrinsic muscles of the eye allows early decisions on the most appropriate therapeutic choice.
