ROLE OF MAGNETIC-RESONANCE-IMAGING IN THE DIAGNOSIS AND PROGNOSIS OF GROWTH-HORMONE DEFICIENCY

OBJECTIVE In patients with congenital GH deficiency (GHD), magnetic re sonance imaging (MRI) has revealed morphological abnormalities such as pituitary hypoplasia, absence of the stalk and ectopia of the posteri or pituitary (PPE). Our study was aimed at investigating the possible relationship between neuroradiological images and the presence of isol ated GH or multiple pituitary hormone deficiency. DESIGN We studied 12 1 patients, aged 0.3-25 years, with isolated GHD (IGHD, 81 cases) or m ultiple pituitary hormone deficiency (MPHD, 40 cases). Of 81 IGHD pati ents, 50 were at prepubertal and 22 at pubertal age, while 9 had a del ayed onset of puberty. Out of 40 MPHD patients, 25 were at prepubertal age and 15 at the age of puberty. RESULTS Pituitary hypoplasia, defin ed as a gland with a height of less than -2 SD for age, was observed m ore frequently in prepubertal (66%) than pubertal (18%) IGHD patients. It was also found in the majority of MPHD patients of prepubertal (76 %) and pubertal age (80%), and of IGHD patients with delayed onset of puberty (100%). Mean+/-SEM pituitary height was significantly lower(P <0.001) in both prepubertal IGHD (-2.70+/-0.20 SD) and MPHD children ( -3.10+/-0.39 SD) than in IGHD patients with normal onset of puberty (- 1.55+/-0.2 SD). A significantly greater pituitary height was observed in IGHD patients with normal onset of puberty (-1.55+/-0.20 SD) than i n MPHD patients at the age of puberty (-4.38+/-0.61 SD, P <0.001) and in IGHD subjects with delayed onset of puberty (-4.06+/-0.41 SD, P <0. 001). An important increase (P <0.02) in the height of the pituitary g land was found in 6 of the 9 patients with delayed puberty when they w ere re-evaluated after completing their spontaneous pubertal developme nt. The frequency of other MRI abnormalities (PPE, stalk transection) was significantly higher in MPHD patients than in IGHD patients (P <0. 001). CONCLUSION Our results confirm the usefulness of MRI in the eval uation of children affected by GH deficiency. The association of gland hypoplasia with other MR abnormalities could suggest the presence of multiple anterior pituitary deficiencies. Finally, puberty seems to pl ay an important role in the increase of pituitary size in multiple pit uitary hormone deficiency and isolated GH deficiency patients.