Background: Most cases of multiple pituitary hormone deficiency (MPHD) are acquired and genetic aetiology is rare in the UK. We have investigated whether environmental factors are implicated in idiopathic MPHD (IMPHD).
Objective and hypotheses: In IMPHD to determine perinatal risk factors and radiological features; to identify the regional epidemiology.
Method: Systematic analysis of paediatric IMPHD cases in the UK West Midlands region from 1998 to 2014. Diagnosis was based on two or more hormonal deficits. Patients with acquired hypopituitarism and also midline and/or optic nerve abnormalities (septo-optic dysplasia) were excluded. Districts with higher incidence of IMPHD was compared.
Results: patients (33 (42%) female) were identified. Caucasian (78%), Asian (16%) and Afro-Caribbean (6%) ethnicities were comparable to the regional background population. 52% were normal vaginal deliveries, with 36 and 10% born via LSCS and instrumental deliveries respectively. Median maternal age was 27 years (UK mean 29.3) and 52% were primigravida (UK Default 43%). During pregnancy 27% smoked, 13% consumed alcohol, 13% required prescribed medications but none reported recreational drug use. 22% had 1st trimester antenatal bleeding (cf. 7% nationally). TSH, GH, gonadotropin, ACTH and ADH deficiencies occurred in 79, 67, 54, 36, and 12% respectively). 80% (n=62) of pituitary MRIs were abnormal: 49% involving the anterior pituitary and 62% the posterior pituitary (including 37% with ectopia (EPP)). 34 (43%) were born in Birmingham which has 20% of the regional population, with clustering in other urban areas with socio-economic deprivation.
Conclusion: IMPHD appears associated with environmental risk factors implicated in structural and/or functional disturbance in foetal pituitary development. Association with young maternal age, primagravida birth and antenatal bleeding as with SOD along with clustering in areas of socio-economic deprivation raise the possibility that IMPHD also shares a similar aetiological background.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology