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Congenital hypopituitarism: clinico-radiological correlation
Pinaki Dutta1, Anil Bhansali, Paramjeet Singh
1Department of Endocrinology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Journal of Pediatric Endocrinology & Metabolism : JPEM
|December 22, 2009
Summary
Non-tumoral childhood hypopituitarism shows frequent imaging abnormalities. These findings correlate most strongly with growth hormone (GH) deficiency severity, not the number of hormone deficiencies or breech birth presentation.
Area of Science:
- Pediatric Endocrinology
- Neuroradiology
- Genetics
Background:
- Non-tumoral causes are a significant factor in childhood hypopituitarism.
- Structural abnormalities in the pituitary stalk and gland are linked to the number and severity of hormone deficiencies.
- This study investigates the relationship between clinical presentation and radiological findings in non-tumoral hypopituitarism.
Purpose of the Study:
- To correlate clinico-radiological findings in children with non-tumoral hypopituitarism.
- To determine the relationship between specific MRI abnormalities and hormone deficiencies.
- To assess the correlation between imaging findings, GH deficiency severity, and birth presentation.
Main Methods:
- Thirty-one children with congenital hypopituitarism underwent pharmacological testing for GH deficiency.
- MRI was used to assess pituitary structure, including the stalk, gland, and posterior pituitary bright spot (EPPBS).
- Radiological criteria (MRI tetrad) were correlated with hormone deficiencies, GH deficiency severity, and presentation at birth.
Main Results:
- The MRI tetrad was more prevalent in isolated GH deficiency (IGHD) than multiple pituitary hormone deficiencies (MPHD) and correlated with GH deficiency severity.
- Imaging abnormalities were more frequent in patients with severe GH deficiency (peak GH < 3 ng/ml).
- Breech presentation was associated with a higher frequency of imaging abnormalities and correlated with GH deficiency severity.
Conclusions:
- Imaging abnormalities are common in non-tumoral hypopituitarism.
- These abnormalities correlate more strongly with the severity of GH deficiency than with the number of hormone deficiencies.
- The severity of GH deficiency and breech presentation are key factors associated with imaging findings.
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