().
8ihE\lifgj`hl`Xki)''02-.( 1().$()0 :c`e`ZXc&JZ`\ek`ÔZefk\
I<JJFEÛE:@8D8>EyK@:8KI@;@D<EJ@FE8CEF;@8>EäJK@:F;8;F<Ex8;<:LJ?@E>
E\lif\e[fZi`efcf^p:\ek\i#:fdgc\of?fjg`kXcXiJXekX:XjX#Le`m\ij`[X[\=\[\iXc[\:`eZ`Xj[XJX[\[\Gfikf8c\^i\L=:JG8 #Gfikf8c\^i\IJ#9iXq`c% I\Z\`m\[.Alcp)''/#i\Z\`m\[`eÔeXc]fid*'J\gk\dY\i)''/%8ZZ\gk\[('Efm\dY\i)''/%
;iX%:Xifc`eX>XiZ`XJfXi\jC\\jÆIlX=Xi`XJXekfj(*)$0'-.'$(,'Gfikf8c\^i\IJ$9iXj`c%<$dX`c1[iXZXifc`eX7Z`jX%d\[%Yi
JGF@C<;>I8;@<EKI<:8CC<;8:HL@J@K@FE@E
K?<JK<8;PJK8K<=FID8>E<K@:I<JFE8E:<
@D8>@E>;@8>EFJ@JF=:LJ?@E>;@J<8J<
:Xifc`eX>%J%C\\j#Ac`X=%J%G\i\`iX$C`dX#I\e\C\e_Xi[k#
M\iXD%=%J`cm\`iX#E\cjfeG%=\ii\`iX#D`i`Xd:%Fc`m\`iX
:lj_`e^[`j\Xj\:; `jXiXi\Xe[[\Y`c`kXk`e^\e[f$ Zi`efgXk_pZXlj\[YpXeX[i\efZfik`Zfkifg`e8:K? $j\$ Zi\k`e^g`kl`kXipX[\efdX%K_\[`X^efj`jf]:;Zfej`jkj `ej`^ej#jpdgkfdjXe[cXYfiXkfi`Xc[\k\Zk`fef]\e[f^$ \eflj_pg\iZfik`jfc`jdXcfe^n`k_`[\ek`ÔZXk`fef]k_\ g`kl`kXipkldfi(%;\k\Zk`fef]8:K?$j\Zi\k`e^g`kl`kXip
X[\efdXjYp`dX^`e^k\Z_e`hl\j_XjXcnXpjY\\eXZ_Xc$ c\e^\%>X[fc`e`ld$\e_XeZ\[dX^e\k`Zi\jfeXeZ\`dX^$ `e^DI@ _Xj[`X^efjk`ZXZZliXZp]fi:;iXe^`e^]ifd+' kf,'(#)#Xe[e\nk\Z_e`hl\j#jlZ_Xjk_\jgf`c\[^iX[`$
\eki\ZXcc\[XZhl`j`k`fe`ek_\jk\X[pjkXk\JG>I DI@ _Xm\Y\\e[\m\cfg\[kf`dgifm\k_\iXk\f]g`kl`kXipkl$ dfi[\k\Zk`fe*$,%
N\i\gfikfeXZXj\`en_`Z_JG>IDI@gifm\[\jj\e$ k`Xc]fiXZ_`\m`e^XeXZZliXk\[`X^efj`jf]:;%
:8J<
8+/$p\Xi$fc[]\dXc\gi\j\ek\[n`k_()dfek_jf]n\`^_k ^X`e#ifle[\[Xe[i\[]XZ\#_X`icfjj#`ek\ej\Xe[XZk`m`kp$c`d$ `k`e^]Xk`^l\#Xik_iXc^`Xj#`eZi\Xj\`eYcff[gi\jjli\c\m\cj#Xe[ j\m\i\fjk\fgfifj`jn`k_jZ_`ld]iXZkli\j%J_\[\e`\[gi\m`$ fljlj\f]^clZfZfik`Zf`[jfiZ_ife`Z[`j\Xj\j#_\X[XZ_\fim`$ jlXcXck\iXk`fe%?`jkfipf]Zfek`el\[lj\f]\eXcXgi`c)'d^h`[# Xc\e[ifeXk\jf[`ld.'d^&n\\b#ZXcZ`ld#,''d^Y`[#m`kXd`e ;)''@LY`[%Feg_pj`ZXc\oXd`eXk`fe#j_\gi\j\ek\[dffe]X$ Z`\j#]XZ`Xcgc\k_fiX#Ycff[gi\jjli\c\m\cjf](+'&0'dd?^#Yl$ ]Xccf_ldg#Z\eki`g\kXcfY\j`kp#gifo`dXclgg\iXe[cfn\ic`dY dljZc\n\Xbe\jj#Xe[_X`i]iX^`c`kp%Efm`fcXZ\fljjki`X\#_`ijlk$ `jdfiXZe\%CXYfiXkfip\mXclXk`fei\m\Xc\[YXjXcZfik`jfcc\m\cj Xk/_1)/%)d^&[C2Zfik`jfcXk)+_1)-d^&[C2)+$_Zfik`jfcli`X1 *'*%+),Æ)(*%.d^&)+_ 2YXjXc8:K?1,/%-'Æ+-g^&dC 2'%,$ d^[\oXd\k_Xjfe\jlggi\jj`fek\jk`e^\m\ip-_]fi/[fj\j1 Zfik`jfc1),%,Xe[)+$_Zfik`jfcli`X1.+'%'2)$d^[\oXd\k_Xjfe\ jlggi\jj`fek\jk`e^\m\ip-_]fi/[fj\j1Zfik`jfc1)'%(Xe[)+$_ Zfik`jfcli`X10/-%+%
G`kl`kXipDI@j_fn\[efidXcg`kl`kXip^cXe[=`^( Xe[Zfd$
glk\[kfdf^iXg_p:K jZXef]k_\Z_\jkXe[XY[fd\e[`j$ Zcfj\[efidXckfdf^iXg_`ZXe[dfig_fcf^`ZXcXjg\Zkf]k_\ X[i\eXc^cXe[j#Xe[Xef[lcXi`dX^\f]'%/Zd`ek_\Z\ekiXci\$ ^`fef]k_\`e]\i`ficfY\f]k_\c\]kcle^#n`k_[\ej`kpf]jf]k gXikj#jc`^_kcpnXmpZfekfli#Xe[f]leZ\ikX`e\mfclk`m\eXkli\ Xe[gfk\ek`Xc%DX^e\k`Zi\jfeXeZ\`dX^\jn\i\i\ZfejkilZk\[ Ypd\Xejf]k_i\\$[`d\ej`feXcJG>I#\o_`Y`k`e^X'%+s'%*$Zd gfjk\ifcXk\iXci`^_k$j`[\[g`kl`kXipd`ZifX[\efdX2g`kl`kXip jkXcbn`k_jc`^_kcpXjpdd\ki`Z`dgcXekXk`feZfii\jgfe[`e^kf k_\XeXkfd`ZmXi`XYc\=`^) %@e]\i`fig\kifjXcj`eljjXdgc`e^ @GJJ nXjg\i]fid\[X]k\i[\jdfgi\jj`ejk`dlcXk`fe('d^@M # n_`Z_`e[`ZXk\[8:K?_pg\ij\Zi\k`fe]ifdk_\i`^_k`e]\i`fi g\kifjXcj`eljKXYc\ %K_\gXk`\ekle[\in\ekkiXejjg_\ef`[Xc jli^\ip#n`k__`jkfcf^`ZXcZfeÔidXk`fef]k_\g`kl`kXipX[\ef$ dX`ddlef_`jkfZ_\d`ZXccpgfj`k`m\]fi8:K?%
8ihE\lifgj`hl`Xki)''02-.(
()/
:lj_`e^[`j\Xj\1DI@ C\\j\kXc%
;@J:LJJ@FE
@ek_\ZXj\gi\j\ek\[_\i\#k_\gXk`\ekj_fn\[Zc`e`ZXc ]\Xkli\jZfdgXk`Yc\n`k_:lj_`e^jpe[ifd\1Z\eki`g\kXc fY\j`kp#Yl]Xccf_ldg#dffe]XZ`\j#]XZ`Xcgc\k_fiX#gifo`$ dXcdljZc\n\Xbe\jj#dljZlcXi_pgfkifg_p#_X`i]iX^`c`kp# _pg\ik\ej`fe#Xe[fjk\fgfifj`j(%JZi\\e`e^\oXd`eXk`fej
n\i\gfj`k`m\n`k_`eZi\Xj\[)+$_Zfik`jfcli`XXe[d`[$ e`^_kZfik`jfc%8:K?mXcl\(,g^&dCjl^^\jk\[8:K?$[\$ g\e[\ek_pg\iZfik`jfc`jd%Efjlggi\jj`fen`k__`^_$[fj\ [\oXd\k_Xjfe\XjjfZ`Xk\[n`k_efidXcg`kl`kXipDI@Xe[ gi\j\eZ\f]jdXccglcdfeXipef[lc\jl^^\jk\[Xe\Zkf$ g`Z8:K?$j\Zi\k`e^kldfi%?fn\m\i#Xck_fl^_k_\gi\Z`j\ eXkli\f]k_\glcdfeXipef[lc\Zflc[efkY\ZfeÔid\[# i\ZfejkilZk`feDI@lj`e^k_\JG>Ik\Z_e`hl\kf`[\ek`]p i`^_k$j`[\[g`kl`kXipd`ZifX[\efdXZfdY`e\[n`k_k_\ @GJJZc\Xicpgfj`k`m\i\jlckgifm\[\jj\ek`Xc]fiXZ_`\m`e^ XeXZZliXk\\k`fcf^`ZXc[`X^efj`jf]:;%:cXjj`ZXccp#k_\ [`X^efj`jf]:;`jZfej`[\i\[XjXe@GJ&g\i`g_\iXc$8:K? iXk`fr)%'`ek_\YXjXcjkXk\Xe[r*%'X]k\ijk`dlcXk`fe% Dfi\fm\i#XY`cXk\iXcc\]k&i`^_kfii`^_k&c\]k @GJ^iX[`$
\ekr(%+jl^^\jkjcXk\iXc`qXk`fef]k_\c\j`fe(%8ck_fl^_@GJ
ZXk_\k\i`qXk`fe_XjXZZliXZpf]fecp,.]ficXk\iXc`qXk`fe f]k_\c\j`fe[l\kfXjpdd\ki`\j`em\eflj[iX`eX^\Xe[ kldficfZXk`feZcfj\kfk_\d\Xec`e\#`ek_\gi\j\ekZXj\ cXk\iXc`qXk`fef]k_\c\j`feZflc[Y\Zc\Xicp`e[`ZXk\[@GJ ^iX[`\ek&g\i`g_\iXc$8:K?Xe[YXj\c`e\i`^_k&c\]k4('%' Xe[4**%'X]k\ijk`dlcXk`fe %
?fn\m\i#jfd\]XZkfij_`e[\ik_\Zfii\Zk`[\ek`ÔZX$ k`fef]k_\Zfik`Zfkifg`efdXj#dX`ecpk_\`ik`g`ZXccpjdXcc j`q\0'f]k_\dXi\d`ZifX[\efdXj (#*Xe[k\e[\eZp
kfgi\j\ekj`^ejXe[\e_XeZ\d\ekj`d`cXikfk_fj\f]k_\ efidXcg`kl`kXipk`jjl\*#+%
I\Z\ekjkl[`\j_Xm\[\dfejkiXk\[k_Xkgfjk^X[fc`e$ `ldJG>IDI@[flYc\[k_\[\k\Zk`feiXk\f]g`kl`kXip X[\efdXj`eX[lckj*Xe[Z_`c[i\e,n_\eZfdgXi\[kfZfe$
m\ek`feXcDI@n`k_K($n\`^_k\[jg`e\Z_fJ< j\hl\eZ\j% GXkifeXj\kXc%*_Xm\[\dfejkiXk\[JG>IDI@j\ej`k`m`kp
f]/'`ek_\[\k\Zk`fef]Zfik`Zfkifg`efdXj#jlg\i`fikf k_\+0fYkX`e\[Ypd\Xejf]Zfem\ek`feXcDI@J<%=XZ$ kfijZfeki`Ylk`e^kfXY\kk\ig\i]fidXeZ\f]JG>IDI@ `eZcl[\jlg\i`fijf]kk`jjl\ZfekiXjkXe[`dX^\jfYkX`e\[ ]ifdk_`ee\ij\Zk`fejf](kf(%,ddn`k_Zfej\hl\ekcp _`^_\i`dX^\i\jfclk`fe*#+%=lik_\idfi\#k_\JG>Id\k_f[
`jZ_XiXZk\i`q\[Yp]Xjk\iXZhl`j`k`fef]`dX^\j#d`e`d`q$ `e^Xik`]XZkj]ifddfk`feXe[mXjZlcXiglcjXk`fe*%8efk_\i
i\Z\ekXggc`ZXk`fef]k_`jd\k_f[`jk_\`ekiXfg\iXk`m\ JG>IDI@XjXjli^`ZXcdf[Xc`kp`ekiXejjg_\ef`[Xcjli$ ^\ip#n_`Z_XccfnjX[`]]\i\ek`Xk`feY\kn\\eefidXcg`kl$ `kXipk`jjl\#i\j`[lXckldfik`jjl\#ÔYifj`j#i\XZk`m\`eÕXd$ dXkfipXck\iXk`fej#Xe[_\dXkfdX]fidXk`fe#[\Zi\Xj`e^ dfiY`[`kpXjjfZ`Xk\[n`k_k_\jli^\ipXe[`eZi\Xj`e^fm\i$ XccjlZZ\jjiXk\X]k\ijli^\ip-%
@k`j`dgfikXekkfi\Zf^e`q\k_Xk`ek_\ZXj\i\gfik\[ _\i\#Yfk_jkl[`\jn\i\ZXii`\[flkj`dlckXe\fljcp#[`j$ ZXi[`e^k_\gfjj`Y`c`kpf][`]]\i\eki\jlckjY\kn\\ek_\ k\Z_e`hl\j[l\kfgfjj`Yc\kldfi^ifnk_%
K_\Zli\iXk\]fi:;gXk`\ekjn`k_[\k\Zk\[kldfi`j /'Æ0'#Ylk[ifgjkf,'Æ.'n_\ek_\c\j`feZXeefk Y\cfZXc`q\[gi\fg\iXk`m\cp.#/%9\j`[\j`eZi\Xj`e^k_\Zli\
iXk\#k_\`[\ek`ÔZXk`fef]k_\8:K?$j\Zi\k`e^kldfi[\$ Zi\Xj\jdfiY`[`kpXjjfZ`Xk\[n`k_:;`ekiXejjg_\ef`[Xc
=`^)%K_i\\$[`d\ej`feXcJG>IDI`dX^\\o_`Y`k`e^X'%+s'%*$Zd gfjk\ifcXk\iXci`^_k$j`[\[g`kl`kXipd`ZifX[\efdXXiifn %G`kl`kXip jkXcbn`k_jc`^_kcpXjpdd\ki`Z`dgcXekXk`feZfii\jgfe[`e^kfk_\Xe$ Xkfd`ZmXi`XYc\`jfYj\im\[%
KXYc\%I\jlckjf]`e]\i`fig\kifjXcj`eljjXdgc`e^X]k\i[\jdfgi\jj`ejk`dlcXk`fe('d^@M `e[`ZXk`e^8:K?_pg\ij\Zi\k`fe]ifdk_\ i`^_k`e]\i`fig\kifjXcj`elj%
8:K? 'Æ+-g^&dC
K`d\' K`d\*d`e
X]k\i;;8MG
K`d\,d`e X]k\i;;8MG
K`d\('d`e X]k\i;;8MG
C@GJ ,/%' *.%+ )0%0 (*/%'
I@GJ ,.0%' 5(),'%' ,..%' +./%'
G\i`g_\iXc +0%. (*%* -*%- ,(%.
8ihE\lifgj`hl`Xki)''02-.(
()0
:lj_`e^[`j\Xj\1DI@ C\\j\kXc%
jli^\ip#i\[lZ`e^k_\`eZ`[\eZ\f]_pgfg`kl`kXi`jdXe[ Z\i\Yifjg`eXcÕl`[c\XbZXlj\[Ypdlck`gc\jli^`ZXcg`$ kl`kXip\ogcfiXk`fe(#+%K_lj#n\_`^_c`^_kk_\`dgfikXeZ\
f]k_\[\m\cfgd\ekf]k\Z_e`hl\jXe[lj\f]XjjfZ`Xk\[ _`^_$XZZliXZp`dX^`e^d\k_f[j`ek_\j\gXk`\ekj%
@eZfeZclj`fe#JG>IDI@gifm\[jlg\i`fikfZfem\e$ k`feXcDI@J<`ek_\[\k\Zk`fef]g`kl`kXipkldfij#\j$ g\Z`Xccpf]jljg\Zk\[Zfik`Zfkifg`efdXj%=fik_`ji\Xjfe# k_\Xlk_fijjl^^\jkk_\`eZclj`fef]k_`jd\k_f[`ek_\ \mXclXk`fegifkfZfc]fik_\j\c\j`fej%
I<=<I<E:<J
1. Saad MJA, Maciel RMB, Mendonça BB. Endocrinologia. São Paulo: Atheneu, 2007:81-96.
2. Davis WL, Lee JN, King BD, Harnsberger HR. Dynamic
contrast-en-hanced MR imaging of the pituitary gland with fast spin-echo tech-nique. J Magn Reson Imaging 1994;4:509-511.
3. Patronas N, Bulakbasi N, Stratakis CA, et al. Spoiled gradient recalled acquisition in the steady state technique is superior to conventional postcontrast spin echo technique for magnetic resonance imaging de-tection of adrenocorticotropin-secreting pituitary tumors. J Clin Endo-crinol Metab 2003;88:1565-1569.
%DWLVWD'&RXUNRXWVDNLV1$2OGÀHOG(+HWDO'HWHFWLRQRIDGUHQR -corticotropin-secreting pituitary adenomas by magnetic resonance im-aging in children and adolescents with cushing disease. J Clin Endo-crinol Metab 2005;90:5134-5140.
/DIIHUW\$53DWURQDV1-*ROGEHUJ32OGÀHOG(+6WUDWDNLV&$7KH diagnostic accuracy of pituitary magnetic resonance imaging is en-hanced by the use of fast spoiled grass. Pediatr Res 1999;45:92. 6. Pergolizzi RS Jr, Navabi A, Schwartz RB, et al. Intra-operative MR
guid-ance during trans-sphenoidal pituitary resection: preliminary results. J Magn Reson Imaging 2001;13:136-141.
0RVKDQJ7-U&XVKLQJ·VGLVHDVH\HDUVODWHUDQGWKHEHDWJRHVRQ-Clin Endocrinol Metab 2003;88:31-33.
