Hypothalamic-pituitary axis MRI findings in pediatric endocrine disorders: A retrospective study

Magnetic resonance imaging (MRI) of the hypothalamic-pituitary axis (HPA) is widely used in pediatric endocrinology, yet the clinical relevance of structural abnormalities remains debated.

To assess the diagnostic yield of HPA MRI in children with endocrine disorders and identify clinical/hormonal predictors of clinically relevant findings.

We retrospectively analysed a total of 202 patients (1 month to 17 years) evaluated from 2018 through 2023 for suspected HPA dysfunction. Diagnostic groups included isolated growth hormone deficiency (IGHD), multiple pituitary hormone deficiency (MPHD), short stature without growth hormone deficiency (SSWGD), central precocious puberty (CPP), central diabetes insipidus (CDI), and pituitary hypersecretion syndrome (PHS). MRI findings were classified as normal, relevant, or incidental. Logistic regression and ROC analysis were used to identify predictive factors.

Abnormal MRI findings were identified in 29.2% of patients (59/202); 14.9% (30/202) were clinically relevant and 14.4% (29/202), incidental. Diagnostic yield (any abnormal finding) was highest in MPHD (100%) and CDI (87.5%), followed by PHS (40.0%), SSWGD (30.8%), CPP (26.4%) and IGHD (23.2%). In IGHD, lower GH peaks on the exercise-propranolol test were significantly associated with abnormal MRI findings (OR, 3.98; 95%CI, 1.53-10.30; P=.026). There were no predictors for CPP. Incidental lesions were most common in CPP and IGHD.

MRI showed the highest diagnostic yield in MPHD and CDI. In IGHD, lower GH peak values may help guide selective imaging, while in CPP the lack of reliable predictors supports routine MRI. Multidisciplinary interpretation remains essential to contextualise incidental findings.