Incidence and characteristics of Pituitary lesions in children and adolescents with Growth hormone deficiency

Brain Imaging in Growth Hormone Deficiency

Abstract

Background: Growth hormone deficiency (GHD) is associated with many structural abnormalities in hypothalamic pituitary region. Magnetic resonance imaging (MRI) is the imaging of choice to visualize the pituitary gland and its nearby structure and is considered an important diagnostic tool for the diagnosis of GHD.

Objective: To determine the incidence and characteristic of pituitary lesions in children and adolescent with GHD.

Methodology: Retrospective cross-sectional study conducted at the department of paediatric radiology, University of Child Health Sciences, The Children’s Hospital Lahore over the period of 3 years.  MRI brain pituitary protocol of all children and adolescents with clinically and biochemically confirmed GHD were evaluated by two senior paediatric radiology consultants to look for any abnormality in hypothalamic pituitary area. Spectrum of different abnormal MRI findings and association of these findings with type and severity of GHD (mild or moderate) was statistically evaluated.

Results: Total 26 cases of GHD (18 male) were identified with mean age at diagnosis 6.98 year (3 months to 16 years). Mild GHD was found in 3 cases and 23 had severe GHD. Fifteen cases (57.70 %) were found to have isolated GHD (IGHD), and 11 cases (42.30 %) had multiple pituitary hormone deficiency (MPHD).

Normal brain imaging was found in 10 cases (38.46%) and 16 cases (61.54 %) had abnormal MRI brain. Isolated hypoplastic anterior pituitary in the most common finding (10 cases, 62.50 %), followed by hypoplastic anterior pituitary with thinning of pituitary stalk, hypoplastic anterior pituitary with absent posterior pituitary and thinning of pituitary stalk, hypoplastic anterior pituitary with thinning of corpus callosum and Rathke cleft cyst and empty sella turcica. It was observed that there was no association of abnormal MRI brain with severity of GHD. However, it was found that children with MPHD tend to have increased tendency of abnormality in MRI brain (81.82 %) as compared to IGHD cases (46.67 %).

Conclusion: MRI brain pituitary protocol is  important in diagnosing children with GHD and looking for its underlying etiology.