MRI features of growth hormone deficiency in children with short stature caused by pituitary lesions

Abstract

We verified the advantages of using magnetic resonance imaging (MRI) for improving the diagnostic quality of growth hormone deficiency (GHD) in children with short stature caused by pituitary lesions. Clinical data obtained from 577 GHD patients with short stature caused by pituitary lesions were retrospectively analyzed. There were 354 cases (61.3%) with anterior pituitary dysplasia; 45 cases (7.8%) of pituitary stalk interruption syndrome (PSIS); 15 cases (2.6%) of pituitary hyperplasia due to primary hypothyroidism; 38 cases (6.6%) of Rathke cleft cyst; 68 cases (11.8%) of empty sella syndrome; 16 cases (2.8%) of pituitary invasion from Langerhans cell histiocytosis; 2 cases (0.3%) of sellar regional arachnoid cyst and 39 cases (6.8%) of craniopharyngioma. MRI results showed that the height of anterior pituitary in patients was less than normal. Location, size and signals of posterior pituitary and pituitary stalk were normal in anterior pituitary dysplasia. In all cases pituitary hyperplasia was caused by hypothyroidism. MRI results showed that anterior pituitary was enlarged, and we detected upward apophysis and obvious homogeneous enhancement. There were no pituitary stalk interruption and abnormal signal. We also observed that after hormone replacement therapy the size of pituitary gland was reduced. Anterior pituitary atrophy was observed in Rathke cleft cyst, empty sella syndrome, sellar regional arachnoid cyst and craniopharyngioma. The microstructure of hypophysis and sellar region was studied with MRI. We detected pituitary lesions, and the characteristics of various pituitary diseases of GHD in children with short stature. It was concluded that in children with GHD caused by pituitary lesions, MRI was an excellent method for early diagnosis. This method offers clinical practicability and we believe it can be used for differential diagnosis and to monitor the therapeutic effects.

Keywords: growth hormone deficiency; magnetic resonance imaging; pituitary.

Figure 1.

(A) Male, 5 years of age, anterior pituitary dysplasia. He had ‘growth retardation and short stature’, characterized by thin and small anterior pituitary and the existence of high signal of posterior pituitary. (B and C) Female, 6 years of age, pituitary stalk interruption syndrome. She had ‘growth retardation and short stature’, characterized by thin and small anterior pituitary, no pituitary stalk and the existence of high signal of posterior pituitary T1. (D-F) Female, 10 years of age, pituitary hyperplasia due to primary hypothyroidism. She had ‘growth retardation’, characterized by anterior pituitary enlargement and uniform enhancement in case of enhancement scanning. (F) Pituitary of a patient returned to normal size after treatment by re-examination of the magnetic resonance imaging.

Figure 2.

(A and B) Female, 7 years of age, Rathke cleft cyst. She had ‘growth retardation and short stature’, characterized by cystic space-occupying between anterior pituitary and posterior pituitary, low signal of T1, atrophy of anterior pituitary under compression, and no enhancement of capsule wall and content in case of enhancement scanning. (C and D) Male, 9 years of age, empty sella syndrome. He had ‘growth retardation and short stature’, characterized by empty sella turcica, taking on cerebrospinal fluid signal and atrophy of pituitary under compression. (E and F) Male, 6 years of age, LCH pituitary invasion. He had ‘polydipsia polyuria and short stature’, characterized by normal size and signal of anterior pituitary, high signal of posterior pituitary lost on T1, pituitary stalk thickening and obvious enhancement. LCH, Langerhans cell histiocytosis.

Figure 3.

(A-C) Male, 10 years of age, sellar regional arachnoid cyst. He had ‘growth retardation and short stature’, characterized by atrophy of sellar region close to pituitary under compression, basically same signal with cerebrospinal fluid signal, low signal of DWI sequence, and no enhancement of capsule wall and content in case of enhancement scanning. (D-F) Female, 8 years of age, craniopharyngioma. She had ‘growth retardation and blurred vision’, characterized by atrophy of sellar region close to pituitary under compression and obvious enhancement of capsule wall in case of enhancement scanning. (F) Eggshell calcification of lesion. DWI, diffusion weighted imaging.