Pituitary hypointensity: Hemochromatosis as an overlooked cause of hypogonadotropic hypogonadism

Hemochromatosis (HFE) is caused by abnormal accumulation of iron in the parenchymal cells, eventually leading to dysfunction of the involved organs. It can be either primary (or genetic) or secondary (or acquired). Due to the presence of the blood-brain barrier (BBB), iron deposition in the central nervous system is rare but structures lying outside the BBB such as choroid plexus, pituitary, and circumventricular organs are commonly involved. This case series describes 2 cases of pituitary HFE, both presenting with hypogonadotropic hypogonadism, which were diagnosed by magnetic resonance imaging (MRI). In both the cases, T2-weighted and susceptibility-weighted imaging (SWI) images demonstrated markedly low signal in anterior pituitary and choroid plexus with patchy areas of non-enhancement seen on post contrast images. Hence, contrast-enhanced MRI with SWI sequences should be used as non-invasive tool in patients suspected of pituitary gland iron overload.