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[Role of magnetic resonance imaging in non-neoplastic hypothalamo-hypophyseal pathology]
R Brauner1, M Argyropoulou, F Perignon
1Unité d'Endocrinologie, Hôpital et Faculté Necker-Enfants Malades, Paris.
Insights
Magnetic resonance imaging (MRI) aids in diagnosing hypothalamo-pituitary disorders. It helps identify pituitary insufficiency and aids therapeutic decisions in conditions like central precocious puberty.
Area of Science:
- Pediatric Endocrinology
- Neuroradiology
- Diagnostic Imaging
Context:
- Nonneoplastic hypothalamo-pituitary disorders present diagnostic challenges.
- Accurate assessment of pituitary gland size is crucial for evaluating hormonal deficiencies and precocious puberty.
- Magnetic resonance imaging (MRI) offers detailed anatomical visualization of the pituitary and surrounding structures.
Purpose:
- To evaluate the diagnostic, therapeutic, and pathogenetic utility of MRI in nonneoplastic hypothalamo-pituitary disorders.
- To correlate age-specific pituitary height measurements with growth hormone deficiency and central precocious puberty (CPP).
- To assess MRI's role in differentiating between transient and permanent growth hormone deficiency and in guiding treatment for CPP.
Summary:
- MRI revealed decreased age-specific pituitary height in 100% of children with pituitary stalk interruption syndrome and 60% with idiopathic growth hormone deficiency.
- In girls with central precocious puberty (CPP), MRI showed normal pituitary height in premature thelarche, normal in mild CPP, and increased height in 70% of evolutive CPP cases.
- MRI is valuable for diagnosing pituitary insufficiency, predicting multiple anterior pituitary deficiencies in patients with anatomical abnormalities, and aiding therapeutic decisions in CPP.
Impact:
- MRI provides crucial diagnostic and prognostic information for hypothalamo-pituitary disorders, including growth hormone deficiency and CPP.
- Findings assist clinicians in making informed therapeutic decisions, potentially improving patient outcomes.
- This study underscores the importance of advanced imaging techniques in pediatric endocrinology and neuroimaging.
Abstract:
This study was designed to evaluate the diagnostic, therapeutic, and pathogenetic data provided by magnetic resonance imaging (MRI) in nonneoplastic hypothalamo-pituitary disorders. After determination of age-specific pituitary heights, 46 children with idiopathic growth hormone deficiency (GH peak < 8 ng/ml) were studied. Twenty-nine patients (group I) had pituitary stalk interruption syndrome and 17 (group II) had no anatomic abnormalities. Age-specific pituitary height was decreased by more than 2 SDs in all group I patients versus only 60% (10/17) of group II patients. The GH deficiency was transient in 4 of the 7 children with normal pituitary findings. Forty-seven girls with breast development before eight years of age were also studied: age-specific pituitary height was normal in all girls with premature thelarche and 68% of girls with mild form of central precocious puberty (CPP). Conversely, in 70% of girls with evolutive CPP, age-specific pituitary height was increased by more than 2 SDs. These data show that MRI is useful for the diagnosis of pituitary insufficiency and that multiple anterior pituitary deficiencies can be expected in patients with anatomic abnormalities. MRI is of diagnostic and prognostic usefulness in CPP and, therefore, is of assistance in making therapeutic decisions.