Related Experiment Videos
[Pituitary stalk transection syndrome]
C Barbeau1, B Jouret, D Gallegos
1Service d'endocrinologie pédiatrique, CHU Purpan, Toulouse, France.
Insights
Pituitary stalk transection often causes growth hormone deficiency in children, progressing to panhypopituitarism. Early detection and regular monitoring are crucial for managing this condition.
Area of Science:
- Pediatric Endocrinology
- Neuroendocrinology
- Pediatric Radiology
Context:
- Pituitary stalk transection (PST) is a recognized cause of growth hormone (GH) deficiency in children.
- The syndrome is associated with various etiological factors including fetal distress, cranial trauma, and midline anomalies.
- Clinical manifestations range from neonatal hypoglycemia to decreased growth velocity and diabetes insipidus.
Purpose:
- To investigate the clinical characteristics and hormonal deficiencies associated with pituitary stalk transection in a pediatric cohort.
- To assess the progression of hormonal deficits in children diagnosed with PST.
- To highlight the importance of early diagnosis and ongoing management of PST.
Summary:
- A study of 22 children with PST revealed complete GH deficiency in 19 cases, often presenting early.
- Coexisting deficiencies in ACTH, TSH, and gonadotropins were common, with diabetes insipidus present in some cases.
- Hormonal anomalies demonstrated a progressive pattern, evolving from isolated GH deficiency to multiple pituitary hormone deficiencies.
Impact:
- PST is a significant cause of pediatric endocrine dysfunction, necessitating heightened clinical suspicion.
- The progressive nature of PST towards panhypopituitarism underscores the need for regular clinical and hormonal surveillance.
- This research emphasizes the importance of considering PST in children with relevant risk factors and endocrine abnormalities.
Background:
Pituitary stalk transection is a non-negligible cause of growth hormone (GH) deficiency.
Population And Methods:
We studied 22 children (13 boys, nine girls) aged at the first clinical manifestations from 2 days to 10 years (average = 5.33 +/- 2 years). Pituitary stalk transection was assessed by the means of magnetic resonance imaging (MRI). The children's past history showed fetal distress in 12 cases (54.5%), cranial trauma in three (13%) and a midline anomaly in three (13%). The first clinical manifestations were neonatal hypoglycemia (two cases), decreased growth velocity (18 cases) and diabetes insipidus (two cases).
Results:
GH deficiency was complete, present from the onset in 19 of 22 cases and isolated in four. Fifteen of 22 cases had adreno-corticotrophic hormone (ACTH) and thyroid stimulating hormone (TSH) deficiency. Diabetes insipidus was present in six cases and revealed the syndrome in two. All children older than normal age of puberty (n = 10) had gonadotropin deficiency. In our study, these hormonal anomalies progressed from isolated GH deficiency to multiple hormonal deficiencies.
Conclusion:
The recently described stalk transection syndrome is relatively frequent and should be suspected after cranial trauma or fetal distress syndrome. The outcome is progressive evolution towards panhypopituitarism and these patients require regular clinical survey and hormonal controls.