Pathologies involving the pituitary stalk (PS) are generally revealed by the presence of diabetes insipidus. The availability of MRI provides a major diagnostic contribution by enabling the visualization of the site of the culprit lesion, especially when it is small. However, when only an enlarged PS is found, the etiological workup may be difficult, particularly because the biopsy of the stalk is difficult, harmful and often not contributive. The pathological proof of the etiology thus needs to be obtained indirectly. The aim of this article was to provide an accurate review of the literature about PS enlargement in adults describing the differences between the numerous etiologies involved and consequent different diagnostic approaches. The etiological diagnostic procedure begins with the search for possible other lesions suggestive of histiocytosis, sarcoidosis, tuberculosis or other etiologies elsewhere in the body that could be more easily biopsied. We usually perform neck, thorax, abdomen, and pelvis CT scan; positron emission tomography scan; bone scan; or other imaging methods when we suspect generalized lesions. Measurement of serum markers such as human chorionic gonadotropin, alpha-fetoprotein, angiotensin converting enzyme, and IgG4 may also be helpful. Obviously, in the presence of an underlying carcinoma (particularly breast or bronchopulmonary), one must first consider a metastasis located in the PS. In the case of an isolated PS enlargement, simple monitoring, without histological proof, can be proposed (by repeating MRI at 3-6 months) with the hypothesis of a germinoma (particularly in a teenager or a young adult) that, by increasing in size, necessitates a biopsy. In contrast, a spontaneous diminution of the lesion is suggestive of infundibulo-neurohypophysitis. We prefer not to initiate steroid therapy to monitor the spontaneous course when a watch-and-see attitude is preferred. However, in many cases, the etiological diagnosis remains uncertain, requiring either close monitoring of the lesion or, in exceptional situations, trying to obtain definitive pathological evidence by a biopsy, which, unfortunately, is in most cases performed by the transcranial route. If a simple surveillance is chosen, it has to be very prolonged (annual surveillance). Indeed, progression of histiocytosis or germinoma may be delayed.

中文翻译：

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成人垂体柄增大。

涉及垂体柄 (PS) 的病理通常通过尿崩症的存在来揭示。MRI 的可用性提供了一个主要的诊断贡献，通过使罪犯病变部位的可视化，特别是当它很小时。然而，当仅发现肿大的 PS 时，病因学检查可能很困难，特别是因为茎的活检困难、有害且通常没有贡献。因此需要间接获得病因的病理学证据。本文的目的是对有关成人 PS 扩大的文献进行准确回顾，这些文献描述了所涉及的众多病因和随之而来的不同诊断方法之间的差异。病因诊断程序首先寻找可能提示组织细胞增生症、结节病、结核病或身体其他部位的其他可能更容易活检的病因的其他病变。我们通常进行颈部、胸部、腹部和骨盆CT扫描；正电子发射断层扫描；骨扫描；当我们怀疑全身病变时，或其他影像学方法。测量血清标志物，如人绒毛膜促性腺激素、甲胎蛋白、血管紧张素转化酶和 IgG4 也可能有帮助。显然，在存在潜在癌（特别是乳腺癌或支气管肺癌）的情况下，必须首先考虑位于 PS 的转移。在孤立的 PS 扩大的情况下，简单监测，无需组织学证明，可以提出（通过在 3-6 个月时重复 MRI）假设生殖细胞瘤（特别是在青少年或年轻成人中），随着体积增大，需要进行活检。相反，病变的自发缩小提示漏斗神经垂体炎。当首选观察和观察的态度时，我们不希望启动类固醇治疗来监测自发过程。然而，在许多情况下，病因诊断仍然不确定，需要密切监测病变，或者在特殊情况下，试图通过活组织检查获得明确的病理证据，不幸的是，在大多数情况下，这是通过经颅途径进行的。如果选择简单的监视，则必须非常长时间（每年监视）。事实上，组织细胞增生症或生殖细胞瘤的进展可能会延迟。