{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:37Z","timestamp":1784557057017,"version":"3.55.0"},"reference-count":20,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2018,2,23]],"date-time":"2018-02-23T00:00:00Z","timestamp":1519344000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/deed.en_GB"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,2,23]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>A variety of neoplastic, inflammatory and congenital conditions can cause pituitary stalk thickening. Differentiating between these causes is important as targeted treatment may be offered. Diagnostic work-up consists of a thorough history, examination, biochemical analysis and imaging. We present the case of a 33-year-old male who presented with diabetes insipidus and had pituitary stalk thickening on magnetic resonance imaging. Further investigations revealed an elevated CSF \u03b2hCG, which raised the possibility of an intracranial germ cell tumor. However, when repeated on four different assays, the \u03b2hCG levels were discordant. On serial imaging, the pituitary stalk thickening reduced slightly, which would be unexpected for a germ cell tumor. This case raises the difficulties interpreting CSF \u03b2hCG, as not all immunoassays for \u03b2hCG have been validated for use in CSF. The Roche Diagnostics Elecsys and Siemens Centaur assays have been validated for CSF \u03b2hCG, and so we advocate using one of these methods. If unavailable or serum\/CSF results are ambiguous, serial MRI is appropriate, with pituitary stalk biopsy considered if the stalk measures &gt;6.5\u2009mm or other imaging abnormalities are present.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Learning points:<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Most adult patients with central diabetes insipidus have imaging abnormalities on a pituitary MRI. The most common abnormalities are loss of the posterior pituitary bright spot and pituitary stalk thickening, both of which are non-specific.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Causes of pituitary stalk thickening include neoplastic, inflammatory, infective and congenital lesions.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Investigation of pituitary stalk thickening should encompass the many possible causes and include biochemical analyses as well as imaging of the chest, abdomen and pelvis. Further investigations should be guided by the clinical context, but may include testicular ultrasound, CSF analysis and pituitary stalk biopsy.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Germ cell tumors involving the pituitary stalk may be suspected on clinical grounds, but in the absence of a tissue diagnosis (biopsy) confirmation may be difficult and relies on biochemical assessment of blood and possibly CSF as well as serial MRI imaging.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>CSF \u03b2hCG levels should be analyzed on an instrument validated for use in CSF or on multiple instruments, and the pitfalls of testing this marker (false negative in some germ cell tumors, false positives in other conditions, lack of internationally agreed reference ranges for diagnosing germ cell tumors) should be considered when interpreting the results.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-17-0168","type":"journal-article","created":{"date-parts":[[2018,2,23]],"date-time":"2018-02-23T08:50:50Z","timestamp":1519375850000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":0,"title":["Difficulties in cerebrospinal fluid \u03b2hCG interpretation in a patient with an infundibular lesion"],"prefix":"10.1530","volume":"2018","author":[{"given":"Alicia R","family":"Jones","sequence":"first","affiliation":[{"name":"1Department of Endocrinology and DiabetesWestern Health, St Albans, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"McNeil","sequence":"additional","affiliation":[{"name":"2Dorevitch PathologyHeidelberg, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Yates","sequence":"additional","affiliation":[{"name":"1Department of Endocrinology and DiabetesWestern Health, St Albans, Victoria, Australia"},{"name":"3Department of MedicineThe University of Melbourne (Royal Melbourne Hospital), Parkville, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bala","family":"Krishnamurthy","sequence":"additional","affiliation":[{"name":"1Department of Endocrinology and DiabetesWestern Health, St Albans, Victoria, Australia"},{"name":"4Department of MedicineThe University of Melbourne (St. Vincent\u2019s Hospital), Fitzroy, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter S","family":"Hamblin","sequence":"additional","affiliation":[{"name":"1Department of Endocrinology and DiabetesWestern Health, St Albans, Victoria, Australia"},{"name":"5Department of MedicineThe University of Melbourne (Western Campus), St Albans, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"ref41","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s40001-016-0204-2","article-title":"An update on the clinical diagnostic value of \u03b2-hCG and \u03b1FP for intracranial germ cell tumours","volume":"21","year":"2016","journal-title":"European Journal of Medical Research"},{"key":"ref71","doi-asserted-by":"publisher","first-page":"201516","DOI":"10.1016\/S1470-2045(15)00244-2","article-title":"Consensus on the management of intracranial germ - 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