{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T15:11:01Z","timestamp":1778253061334,"version":"3.51.4"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T00:00:00Z","timestamp":1763078400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The incidence of pituitary stalk thickening (PST) has increased in recent years due to the increased utilization of diagnostic MRI of the brain. The clinical significance of PST, appropriate diagnostic workup, and clinical course for these patients is not well documented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>After Institutional Review Board approval, we reviewed the pediatric tumor board and pediatric endocrinology clinic records between 2003 and 2024 to identify patients with PST. We followed the clinical course of these patients to collect applicable data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 29 patients were identified with PST; 11 were excluded due to additional MRI findings, and out of 18 selected patients, 9 were females (50%). Initial diagnostic workup included complete blood count (CBC), basic metabolic panel, serum and cerebrospinal fluid (CSF) tumor markers (AFP, \u03b2-hCG), and skeletal survey. With the initial workup, no patient was diagnosed with neoplasm. Patients were followed with serial MRIs. Five patients (27.7%) displayed progression of PST, warranting biopsy (2 germinomas, 2 Langerhans cell histiocytosis, and 1 inconclusive). The median time to biopsy was 8 months (range 4-26 months). All the patients diagnosed with neoplasm had central diabetes insipidus at presentation, and 3 went on to develop additional endocrine abnormalities. Ten patients had stable PST over a median follow-up period of 19 months (range 0-81 months), and 3 patients had complete resolution of PST during the follow-up period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Most isolated PST among pediatric patients remain stable over time. Serial monitoring of patients with isolated PST can be safe, and not all cases of PST warrant upfront biopsy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/nop\/npaf118","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T13:00:51Z","timestamp":1763038851000},"page":"408-414","source":"Crossref","is-referenced-by-count":0,"title":["Thickened but unclear: Clinical course of isolated pituitary stalk thickening in the pediatric age group"],"prefix":"10.1093","volume":"13","author":[{"given":"Hannah K","family":"Miller","sequence":"first","affiliation":[{"name":"Children\u2019s Hospital of Michigan , Detroit, Michigan (H.K.M.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vikram P","family":"Rajan","sequence":"additional","affiliation":[{"name":"Wayne State University School of Medicine , Detroit, Michigan (V.P.R.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Blunden","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Central Michigan University College of Medicine , Mount Pleasant, Michigan (C.B., H.S.G.)"},{"name":"Division of Endocrinology, Children's Hospital of Michigan , Detroit, Michigan (C.B.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deniz","family":"Altinok","sequence":"additional","affiliation":[{"name":"Wayne State University School of Medicine , Detroit, Michigan (V.P.R.)"},{"name":"Department of Radiology, Wayne State University , Detroit, \u00adMichigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1136-8543","authenticated-orcid":false,"given":"Hamza S","family":"Gorsi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Central Michigan University College of Medicine , Mount Pleasant, Michigan (C.B., H.S.G.)"},{"name":"Division of Hematology\/Oncology, Children's Hospital of Michigan , Detroit, Michigan (H.S.G.)"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,11,14]]},"reference":[{"key":"2026050810222578300_npaf118-B1","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.anpedi.2018.05.002","article-title":"Engrosamiento del tallo hipofisario en ni\u00f1os y adolescentes con diabetes ins\u00edpida central: causas y consecuencias [thickening of the pituitary stalk in children and adolescents with central diabetes insipidus: causes and consequences]","volume":"90","author":"Corredor Andr\u00e9s","year":"2019","journal-title":"An Pediatr (Engl Ed)"},{"key":"2026050810222578300_npaf118-B2","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.1002\/pbc.24577","article-title":"Predictors of neoplastic disease in children with isolated pituitary stalk thickening","volume":"60","author":"Robison","year":"2013","journal-title":"Pediatr Blood Cancer"},{"key":"2026050810222578300_npaf118-B3","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1097\/MED.0b013e3283050844","article-title":"Pituitary stalk lesions","volume":"15","author":"Rupp","year":"2008","journal-title":"Curr Opin Endocrinol Diabetes Obes"},{"key":"2026050810222578300_npaf118-B4","first-page":"1954","article-title":"Thickened pituitary stalk on magnetic resonance imaging in children with central diabetes insipidus","volume":"84","author":"Leger","year":"1999","journal-title":"J Clin Endocrinol Metab"},{"key":"2026050810222578300_npaf118-B5","doi-asserted-by":"crossref","first-page":"868558","DOI":"10.3389\/fendo.2022.868558","article-title":"Pituitary stalk thickening: causes and consequences. The Children\u2019s Memorial Health Institute experience and literature review","volume":"13","author":"Moszczy\u0144ska","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"2026050810222578300_npaf118-B6","doi-asserted-by":"crossref","first-page":"6","DOI":"10.5114\/pdia.2017.67095","article-title":"Langerhans cell histiocytosis in children\u2014a disease with many faces. Recent advances in pathogenesis, diagnostic examinations and treatment","volume":"35","author":"Jezierska","year":"2018","journal-title":"Postepy Dermatol Alergol"},{"key":"2026050810222578300_npaf118-B7","doi-asserted-by":"crossref","first-page":"R151","DOI":"10.1530\/EJE-17-0009","article-title":"Mechanisms in endocrinology: hypophysitis: diagnosis and treatment","volume":"179","author":"Joshi","year":"2018","journal-title":"Eur J Endocrinol"},{"key":"2026050810222578300_npaf118-B8","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1007\/s11912-023-01416-2","article-title":"Intracranial germinomas: diagnosis, pathogenesis, clinical presentation, and management","volume":"25","author":"Kremenevski","year":"2023","journal-title":"Curr Oncol Rep"},{"key":"2026050810222578300_npaf118-B9","first-page":"vdae214","article-title":"Stalking the stalk: isolated pituitary stalk thickening and predictive factors for proliferative disease","volume":"6","author":"Bennett","year":"2024","journal-title":"Neurooncol Adv"},{"key":"2026050810222578300_npaf118-B10","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1210\/clinem\/dgab672","article-title":"Hypophysitis, the growing spectrum of a rare pituitary disease","volume":"107","author":"Langlois","year":"2022","journal-title":"J Clin Endocrinol Metab"},{"key":"2026050810222578300_npaf118-B11","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1016\/S2352-4642(21)00088-2","article-title":"Management of children and young people with idiopathic pituitary stalk thickening, central diabetes insipidus, or both: a national clinical practice consensus guideline","volume":"5","author":"Cerbone","year":"2021","journal-title":"Lancet Child Adolesc Health"},{"key":"2026050810222578300_npaf118-B12","doi-asserted-by":"crossref","first-page":"213","DOI":"10.5114\/pedm.2022.115202","article-title":"Pituitary stalk thickening in patients under 18 years of age\u2014the most common causes and diagnostic procedures. 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