PITUITARY-STALK TRANSECTION

Background. - Pituitary stalk transection is a non-negligible cause of growth hormone (GH) deficiency. Population and methods. - We studied 22 children (13 boys, nine girls) aged at the first clinical manifesta tions from 2 days to 10 years (average = 5.33 +/- 2 years). Pituitary stalk transection was assessed by the means of magnetic resonance imag ing (MRI) The children's past history showed fetal distress in 12 case s (54.5%), cranial trauma in three (13%) and a midline anomaly in thre e (13%), The first clinical manifestations, were neonatal hypoglycemia (two cases), decreased growth velocity (18 cases) and diabetes insipi dus (two cases). Results. - GH deficiency was complete, present from t he onset in 19 of 22 cases and isolated in four. Fifteen of 22 cases h ad adreno-corticotrophic hormone (ACTH) and thyroid stimulating hormon e (TSH) deficiency. Diabetes insipidus was present in sir cases and re vealed the syndrome in two. All children older than normal age of pube rty (n = 10) had gonadotropin deficiency. In our study, these hormonal anomalies progressed from isolated CH deficiency to multiple hormonal deficiencies. Conclusion. - The recently described stalk transection syndrome is relatively frequent and should be suspected after crucial trauma or fetal distress syndrome. The outcome is progressive evolutio n towards panhypopituitarism and these patients require regular clinic al survey and hormonal controls. (C) 1998 Elsevier, Paris.