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Hypothalamic-pituitary dysfunction in growth hormone-deficient patients with pituitary abnormalities
M Maghnie1, F Triulzi, D Larizza
1Department of Pediatrics, University of Pavia, IRCCS Policlinico S. Matteo, Italy.
The Journal of Clinical Endocrinology and Metabolism
|July 1, 1991
Summary
Idiopathic growth hormone deficiency (GHD) in children often involves pituitary abnormalities. Magnetic resonance imaging aids in diagnosing GHD and predicting outcomes, distinguishing isolated GHD from multiple pituitary hormone deficiency.
Area of Science:
- Pediatric Endocrinology
- Neuroendocrinology
- Radiology
Background:
- Idiopathic growth hormone deficiency (GHD) is a common endocrine disorder in children.
- Pituitary abnormalities are frequently observed in patients with GHD, but their specific impact on hormonal deficiencies requires further elucidation.
- Magnetic resonance imaging (MRI) has become a crucial tool for evaluating the hypothalamic-pituitary axis.
Purpose of the Study:
- To investigate the relationship between pituitary abnormalities visualized by MRI and the clinical presentation of idiopathic GHD.
- To determine if specific MRI findings can predict the development of multiple pituitary hormone deficiency (MPHD) in patients with GHD.
- To explore the diagnostic and prognostic value of MRI in managing GHD.
Main Methods:
- Studied 45 patients with idiopathic GHD, categorizing them into groups based on MRI findings and hormonal deficiencies.
- Assessed hypothalamic-pituitary function using growth hormone-releasing hormone (GHRH), thyrotropin-releasing hormone (TRH), and gonadotropin-releasing hormone (GnRH) stimulation tests.
- Quantified sellar and pituitary volumes using MRI.
Main Results:
- Significant differences in pituitary volumes were observed between groups with and without abnormalities.
- Patients with pituitary hypoplasia, undescended stalk, and posterior lobe ectopia showed impaired GH response, suggesting hypothalamic involvement.
- Group II patients (MPHD) exhibited delayed TSH response, hypothyroidism, hyperprolactinemia, adrenal insufficiency, and reduced FSH response, indicating broader pituitary dysfunction.
Conclusions:
- A high incidence of pituitary abnormalities is associated with idiopathic GHD.
- The type of hypothalamic-pituitary abnormality, rather than pituitary size alone, dictates the extent of hormone deficiencies.
- MRI plays a vital role in differentiating patients at risk for MPHD from those with isolated GHD, aiding in diagnosis and prognosis.