Pediatric Endocrine Group
TORONTO — Magnetic resonance imaging of the
pituitary gland is an important clinical tool for predicting future risk for
multiple pituitary hormone deficiencies, researchers said here.
Patients with the classic triad — interrupted or
thin pituitary stalk, absent or ectopic posterior pituitary and anterior
pituitary hyperplasia — are at greater risk for developing multiple
pituitary hormone deficiencies.
Sarah Tsai, MD, FRCPC, a pediatric endocrinology
fellow at Children’s Hospital of Eastern Ontario in Ottawa, Canada, and
colleagues conducted a review to examine the relationship between the degree of
hormonal dysfunction and pituitary anatomy.
The review focused on MRI findings of 52 pediatric
patients who were diagnosed with growth hormone deficiency and had received GH
treatment from 1988 to 2010. Thirty-seven patients were determined to have
isolated GH deficiency; of these, four had the classic triad, eight had varying
degrees of pituitary anatomy abnormalities and 25 had normal MRI findings.
Fifteen of the 52 patients were found to have mutiple pituitary hormone
deficiencies; of these, nine had the classic triad, five had variants of the
triad and one had a normal MRI.
“Of note, there were some mild abnormalities in the
‘normal’ group,” Tsai said.
There were differences in the reading of MRI images from
the initial report in nine of the 52 cases, including four cases of
inappropriate identification of a pituitary microadenoma and five instances of
misidentification of one or more elements of the classic triad.
“It is a good idea to review with a pediatric
neuroradiologist if you have an unexpected result,” Tsai said in an
interview with Endocrine Today. “That may be someone who has
multiple pituitary hormone deficiencies like GH, thyroid-stimulating hormone
and adrenocorticotropin-releasing hormone and they have a normal MRI.”
Tsai noted that patients who have many pituitary hormone
deficiencies tend to have more abnormal pituitary glands on MRI.
“If you have found someone with many deficiencies
and a normal MRI, that would be unusual,” she said.
According to the researchers, the number of patients who
had abnormal pituitary anatomy in this study is consistent with current
A limitation of the study was that the pediatric
neuroradiologist was not blinded to the results of the initial MRI finding nor
the hormone status of the patient. – by Louise Gagnon
For more information:
Disclosure: Dr. Tsai’s research has been supported by a
Canadian Pediatric Endocrinology Group scholarship that was funded by Sandoz.
It is very important when doing the reviews of MRI imaging, in the case
of congenital hypopituitarism, that people realize when looking at hormone
deficits it is an evolving phenotype. It is important to track these children
even if you find that they may have only an isolated GH at the time of
diagnosis. When you find some of these MRI anomalies on the midline, you should
track these children very carefully because they can ultimately develop
multiple hormone deficiencies. The other side of the coin, in patients for whom
you have an absolutely normal MRI and a GH insufficiency, these patients all
need to be retested. The question of whether this is true GH insufficiency
needs to be asked before proposing that GH therapy be continued in adulthood.
– Cheri Deal, MD, PhD
Medicine, University of Montreal
President, Canadian Society of
Endocrinology and Metabolism
Disclosure: Dr. Deal has been a speaker for Pfizer, Eli Lilly,
EMD Serono and Novo Nordisk.