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. 2012 Jan;28(1):121-7.
doi: 10.1007/s00381-011-1594-7. Epub 2011 Sep 21.

Usefulness of magnetic resonance findings of the hypothalamic-pituitary region in the management of short children with growth hormone deficiency: evidence from a longitudinal study

Maria A Kalina  1 , Barbara Kalina-Faska, Katarzyna Gruszczyńska, Jan Baron, Ewa Małecka-Tendera
Affiliations

Usefulness of magnetic resonance findings of the hypothalamic-pituitary region in the management of short children with growth hormone deficiency: evidence from a longitudinal study

Maria A Kalina et al. Childs Nerv Syst. 2012 Jan.

Abstract

Purpose: The purpose of this study is to assess the relationship between magnetic resonance images (MRI) of the hypothalamic-pituitary (H-P) region and response to recombinant human growth hormone (rhGH) treatment in short children with growth hormone deficiency, basing on changes of auxologic parameters, as well as to answer the question if MRI may serve for selecting and monitoring the rhGH responders.

Patients and methods: The study group comprised 85 children treated with rhGH, aged 7.3-18.7 years, followed for the mean period of 3.2 years (range, 2.1-9.5 years). Auxologic parameters (height deficit hSDS, deviation from the mid-parental height hSDS-mpSDS, bone delay index bone age/chronological age ratio (BA/CA)) were assessed before, during and at the end of rhGH treatment; growth velocity was calculated before and during rhGH therapy. Parameters were correlated with the MRI of the H-P region.

Results: Structural anomalies of the H-P region were found in 22 (25.9%) children: empty sella syndrome (ESS) in 12 (14.1%) patients, ectopic posterior pituitary (EPP) in ten (11.8%). Patients' height deficit and their deviation from parental height before rhGH therapy was significantly greater in the EPP group (median hSDS = -3.8; hSDS-mpSDS = -2.5), bone age delay was the greatest in the ESS group (median BA/CA = 0.69), after therapy - in the EPP group (median BA/CA = 0.82). Growth velocity improved in the first year of the rhGH therapy in all groups; however, the most significant acceleration was observed in the EPP group (median delta hSDS = 0.9), then stabilised and was comparable in all groups.

Conclusions: MRI may be helpful in predicting response to the rhGH treatment, providing midline abnormalities are taken into account.

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Figures

Fig. 1
Fig. 1
MRI of the partially empty sella (circle), SE/T1, coronary plane (a) and sagittal plane (b)
Fig. 2
Fig. 2
MRI of the ectopic posterior pituitary (arrow), SE/T1, coronary plane (a) and sagittal plane (b)
Fig. 3
Fig. 3
Box plots presenting height velocity (delta hSDS) in the first 12 months of rGH treatment depending on the MRI of the H-P region. NP normal pituitary, ESS empty sella syndrome, EPP ectopic posterior pituitary. Asterisks represent outlying values
See this image and copyright information in PMC

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