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Pituitary Morphology and Function in 43 Children with Central Diabetes Insipidus
Wendong Liu1, Limin Wang2, Minghua Liu3
1Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China; Department of Pediatrics, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao 266011, China.
Insights
Pediatric central diabetes insipidus (CDI) diagnosis is often delayed. Regular pituitary function monitoring is crucial, especially for children with a pituitary stalk diameter over 4.5 mm, to detect hormone deficiencies.
Area of Science:
- Pediatric Endocrinology
- Neuroendocrinology
- Pediatric Oncology
Background:
- Pediatric central diabetes insipidus (CDI) diagnosis and management are often delayed.
- Timely diagnosis and consistent pituitary function monitoring are essential for affected children.
Purpose of the Study:
- To highlight the importance of regular follow-up and pituitary function monitoring in pediatric CDI.
- To analyze clinical, hormonal, and neuroradiological features of pediatric CDI patients.
Main Methods:
- Retrospective analysis of clinical, hormonal, and neuroradiological data from 43 pediatric CDI patients.
- Data collected at diagnosis and during a 1.5-2 year follow-up period.
- Assessment of pituitary stalk diameter and anterior pituitary hormone deficiencies.
Main Results:
- The mean diagnostic delay for pediatric CDI was over 22 months.
- Polyuria and polydipsia were the most common initial symptoms.
- 53.5% of patients had at least one anterior pituitary hormone deficiency; 8 cases with pituitary stalk diameter > 4.5 mm had multiple deficiencies.
Conclusions:
- Delayed diagnosis is common in pediatric CDI.
- A pituitary stalk diameter greater than 4.5 mm is associated with an increased risk of multiple pituitary hormone deficiencies.
- Long-term MRI and pituitary function follow-up are necessary for children with idiopathic CDI.
Abstract:
Objective. In pediatric central diabetes insipidus (CDI), etiology diagnosis and pituitary function monitoring are usually delayed. This study aimed to illustrate the importance of regular follow-up and pituitary function monitoring in pediatric CDI. Methods. The clinical, hormonal, and neuroradiological characteristics of children with CDI at diagnosis and during 1.5-2-year follow-up were collected and analyzed. Results. The study included 43 CDI patients. The mean interval between initial manifestation and diagnosis was 22.29 ± 3.67 months (range: 2-108 months). The most common complaint was polyuria/polydipsia. Causes included Langerhans cell histiocytosis, germinoma, and craniopharyngioma in 2, 5, and 4 patients; the remaining were idiopathic. No significant changes were found during the 1.5-2 years after CDI diagnosis. Twenty-three of the 43 cases (53.5%) had ≥1 anterior pituitary hormone deficiency. Isolated growth hormone deficiency was the most frequent abnormality (37.5%) and was not associated with pituitary stalk diameter. Multiple pituitary hormone deficiencies were found in 8 cases with pituitary stalk diameter > 4.5 mm. Conclusion. Diagnosis of CDI is usually delayed. CDI with a pituitary stalk diameter > 4.5 mm carries a higher risk of multiple pituitary hormone deficiencies. Long-term MRI and pituitary function follow-ups are necessary for children with idiopathic CDI.
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