ESPE Yearbook of Paediatric Endocrinology

Growth Horm IGF Res. 2021;60-61:101427. doi: 10.1016/j.ghir.2021.101427. PMID: 34592640.

Brief Summary: This retrospective chart review describes abnormalities on Magnetic resonance imaging (MRI), according to severity of growth hormone deficiency (GHD) in children.

MRI of the pituitary gland is recommended following the diagnosis of GHD. In prior studies, provocative GH test results and MRI findings may not correlate well (1). However, it remains less clear whether the likelihood of discovering a serious etiology of GHD, such as a tumor, varies by peak GH level.

These authors investigated this question in a retrospective series of 399 children with GHD from their institute. In children with isolated GHD (IGHD) and multiple pituitary hormone deficiency (MPHD), pituitary abnormalities were more likely to be found in children with peak GH levels at the lowest tier of provocative test results (group A with peak GH < 5.0 ng/mL) compared to higher levels of failed GH test results (group B with peak GH 5.0–7.4 ng/mL and group C with peak GH 7.5–9.9 ng/mL). In group A, 36.9% had an abnormal pituitary vs. 16.7% and 17.0% in groups B and C, respectively. In children with IGHD, abnormal MRI findings were most frequently found in those from group A (28.4%) in comparison to groups B and C (15.3% and 16.9%, respectively).

While these results showed that abnormal MRI findings may be present across all categories of failed GH provocative test results, it is important to note that findings in groups B and C were less frequently “actionable” and all patients with a tumor showed severe GHD (peak GH < 5.0 ng/mL). The authors concluded that further research is needed to inform future guidelines on the necessity of imaging for cases with a GH peak of 5 – 9.9 μg/mL.

References: 1. Neuroradiology. 2021 Jul;63(7):1121-1133. Prevalence of brain MRI findings in children with nonacquired growth hormone deficiency: a systematic review and meta-analysis. PMID: 33611620 DOI: 10.1007/s00234-021-02665-3.