ESPE Abstracts (2019) 92 LB-16

Associations Between Pituitary Abnormalities and Treatment Response in Children with Growth Hormone Deficiency. First Multicenter Study in Portugal

Catarina Diamantino1, Ana Sofia Simões2, Catarina Borges1, Carla Costa3, Carla Pereira4, Paula Vieira5, Ana Luísa Leite6, Ana Cristina Monteiro7, Joana Freitas8, Sandrina Martins9, Maria Teresa Bernardo9, Marcelo Fonseca10, Alice Mirante2


1Hospital de Dona Estefânia- Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal. 2Hospital Pediátrico de Coimbra, Coimbra, Portugal. 3Centro Hospitalar Universitário de São João, Porto, Portugal. 4Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal. 5Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal. 6Centro Hospitalar Vila Nova de Gaia, Vila Nova de Gaia, Portugal. 7Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal. 8Centro Materno Infantil do Norte, Centro Hospitalar do Porto, Porto, Portugal. 9Unidade Local de Saúde do Alto Minho, Barcelos, Portugal. 10Hospital Pedro Hispano, Matosinhos, Portugal


Background/Aims: Magnetic resonance imaging (MRI) is used to investigate the etiology of growth hormone deficiency (GHD). There is a close relationship between structural changes in the pituitary gland and clinical status.

We aimed to investigate the relationship between MRI findings and clinical symptoms and treatment response in children with GHD.

Methods: The study was conducted in nine Department of Pediatric Endocrinology of Portugal. The study group included GHD children treated for at least two years whose magnetic resonance imaging was available. Patients whom were small for gestational age, with clinical syndromes, chronic diseases or acquired GHD were excluded. Clinical presentation, hormonal status and first year growth response were compared between patients with pituitary abnormalities and patients with normal MRI. Results are presented as mean± standard deviation score (SDS) unless stated otherwise.

Results: Three hundred and twenty-one children were included, of which 230 were male (67,6%). The mean age at the start of treatment was 9,68 ± 4 years. Additional hormone deficiencies were found in 44 (13%) of patients. Pituitary MRI showed alterations in 141 (43,9%) patients; several patients showed more than one abnormality: 100 had pituitary hypoplasia, 71 had thin stalk, 58 had ectopic posterior pituitary, 16 had empty sella and 31 had the triad ectopic posterior pituitary, pituitary hypoplasia/aplasia and stalk defects. Patients with pituitary abnormalities started treatment significantly earlier (8,5 ± 1,2 years vs 10,61±3,7 years; P=0,000) and they had a more severe clinical phenotype (height SDS -3,26±1,2 vs -2,89±0,84; P=0,001) than patients with normal MRI. A statistically significant increase was observed in the variation of height increase rate after one year of treatment between the two groups (0,91±1,04 vs 0,59±0,57; P=0,001).

Conclusions: MRI is a useful tool in assessing GHD patients. The presence and type of hypothalamic-pituitary abnormalities provides valuable information regarding the likely severity of the GHD and predicting treatment response.