Background: Brain MRI is an essential tool in the diagnosis of neuroendocrine disorders and aims at detecting anatomical abnormalities and tumors. However, it may lead to the identification of unrelated or questionably related abnormalities in the hypothalamic-pituitary region and/or the rest of the brain parenchyma.
Objective and hypotheses: To establish the prevalence of causal lesions on brain MRI of children evaluated for hypopituitarism, assess the frequency and nature of incidental.
Method: Retrospective single-center study based on the analysis of brain MRI realized with focus on the pituitary region (radiological protocol) from January 1st 2007 to December 31st 2008 for suspected hypopituitarism.
Results: Of the 219 MRI analyzed, 56% showed an anomaly and 34% involved the hypothalamic-pituitary region. Most of these abnormalities were minor and consisted of hypo- or hyper-plasia of the anterior pituitary and cysts. Seven causal lesions (ectopic posterior pituitary, no tumor) were identified (3.2%). Finally, 75 extra-hypothalamic-pituitary lesions were identified of which 61 (28%) were incidental. Twenty-one MRI were repeated after the initial evaluation (9.6%) of which 38% were to control an incidental finding.
Conclusion: Brain MRI performed in the context of anterior pituitary hormone deficiency identified a causal lesion in 3.2% but detected incidental unrelated MRI abnormalities in a large proportion of patients, leading to a high number of repeat examinations. Further work should be done to further refine the indications for brain MRI in these patients and avoid unnecessary examinations and the risk of incidental findings.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology