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Magnetic resonance imaging in the diagnosis of growth hormone deficiency
M Argyropoulou1, F Perignon, R Brauner
1Paediatric Endocrinology Unit, INSERM U30, Hôpital et Faculté Necker-Enfants Malades, Paris, France.
Insights
Magnetic resonance imaging (MRI) helps diagnose growth hormone deficiency. Pituitary stalk interruption syndrome on MRI indicates confirmed deficiency and predicts multiple pituitary hormone issues.
Area of Science:
- Pediatric Endocrinology
- Radiology
- Genetics
Background:
- Idiopathic growth hormone deficiency (GHD) is a significant clinical concern in children.
- Accurate diagnosis and prediction of associated endocrine dysfunctions are crucial for effective management.
Purpose of the Study:
- To evaluate the utility of magnetic resonance imaging (MRI) in diagnosing GHD.
- To determine the association between pituitary anatomy, particularly pituitary stalk interruption syndrome (PSIS), and GHD severity and prognosis.
- To explore potential origins of PSIS.
Main Methods:
- Retrospective analysis of MRI scans in 46 patients with idiopathic GHD.
- Classification into groups based on pituitary anatomy: PSIS versus normal pituitary.
- Comparison of clinical and biochemical parameters between groups, including age of onset, stature, GH peak response, and pituitary dimensions.
Main Results:
- Patients with PSIS (n=29) exhibited significantly shorter pituitary height, earlier GHD onset, smaller stature, and lower GH peak response compared to those with normal pituitary anatomy (n=17).
- Three patients with PSIS had no visible anterior pituitary lobe; 10 patients with normal anatomy had reduced pituitary height.
- PSIS was strongly associated with multiple anterior pituitary deficiencies and suggested an antenatal or genetic origin.
Conclusions:
- MRI evaluation of pituitary gland morphology, especially identifying PSIS, is a valuable diagnostic tool for GHD.
- PSIS is a reliable indicator of confirmed GHD and predicts the likelihood of multiple anterior pituitary hormone deficiencies.
- The findings suggest an early antenatal or genetic etiology for PSIS.
Abstract:
Forty-six patients with idiopathic growth hormone deficiency were examined by magnetic resonance imaging at a mean (+/- SEM) age of 9 +/- 1 years (range 15 days to 20 years). They were classified into two groups according to MRI images: group 1 (n = 29) had pituitary stalk interruption syndrome and group 2 (n = 17) had normal pituitary anatomy. All patients with pituitary stalk interruption had a pituitary height at less than -2 SD for age; three had no visible anterior pituitary lobe. By contrast, the pituitary height was less than normal in only 10 patients (60%) with normal pituitary anatomy. Growth hormone deficiency was transient in one of the seven patients with normal pituitary anatomy and height. The group with pituitary stalk interruption had the first symptom of growth hormone deficiency at an earlier age (2.8 +/- 0.6 vs 5.5 +/- 1.2 years; p less than 0.001), were of smaller stature (-4 +/- 0.2 vs -3 +/- 0.2 SD; p less than 0.01) and had lower GH peak response to provocative testing (3 +/- 0.4 vs 5 +/- 0.5 ng/ml; p less than 0.001) than did the group with normal pituitary anatomy. Their pituitary gland was also shorter (2.5 +/- 0.2 vs 3.5 +/- 0.2 mm; p less than 0.01). All the patients with multiple pituitary deficiencies except one (n = 19) belonged to this group. One girl with pituitary stalk interruption and deficiencies in growth hormone and thyroid-stimulating hormone had advanced central precocious puberty. We conclude that the evaluation of the shape and height of the pituitary gland by MRI is an additional tool for the diagnosis of growth hormone deficiency. The presence of pituitary stalk interruption confirms this diagnosis and is predictive of multiple anterior pituitary deficiencies. The lack of a significant increase in perinatal abnormalities in this group and the association of pituitary stalk interruption with microphallus and with facial or sella abnormalities suggest that this appearance may have an early antenatal origin. The finding of a familial case of pituitary stalk interruption suggests a genetic origin.