ESPE Abstracts (2019) 92 P1-397

Pituitary, Neuroendocrinology and Puberty (2)

Questioning the Value of Brain MRIs in the Evaluation of Children with Isolated Growth Hormone Deficiency

Asaf Oren1,2, Dana Singer1, Mariana Rachmiel3,2, Uri Hamiel3, Shelly Shiran1,2, Liat Ben-Sira1,2, Anita Schachter-Davidov1,2, Ori Eyal1,2

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1Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Tel Aviv, Israel. 2Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. 3Assaf Harofeh Medical Center, Zerifin, Israel


Background: Isolated growth hormone deficiency (IGHD) is a relatively common disorder. Current diagnostic protocols require a brain MRI of the hypothalamus and the hypophysis after establishment of the diagnosis, with the aim of identifying structural defects and specifically rule out an underlying space-occupying lesion. An MRI scan is costly and requires general anesthesia in young children. Data on the contribution of brain MRI in diagnosing children with IGHD are sparse.

Objectives: To examine the yield of brain MRI in the evaluation of children with IGHD and to define clinical and laboratory parameters that justify its performance.

Methods: A retrospective chart review of all children (<18 years) diagnosed with IGHD at two pediatric endocrinology units between 2008 and 2018 for auxologic, laboratory, and brain MRI findings.

Results: The study included 129 children (72 boys) with confirmed IGHD. The mean age at diagnosis was 7.5 ± 3.8 years (median 7.7 years, range 0.8-15.9). Boys were diagnosed at a younger age than girls (6.8 ± 3.7 vs. 8.5 ± 3.8 years, respectively, p=0.02). The mean height SDS at diagnosis was -2.2 ± 0.8. The mean height deficit SDS (defined as the difference between height SDS at diagnosis and mid-parental height SDS) was -1.7 ± 0.9. Five children (3.9%) had pathologic findings on their MRI: two had ectopic posterior hypophysis, two had hypoplastic hypophysis and one had Rathke cleft cyst. Six children (4.6%) had incidental findings of Chiari type 1 malformation. No space-occupying lesion was detected. The mean height deficit SDS among the children with pathological MRIs was -3.2 ± 1.4 vs. -1.6 ± 0.8 amog the children with normal MRIs (p=0.007). Both a height deficit threshold of ≥2 SDS and a peak GH level threshold of ≤ 6.5 µg/liter identified all the pathological cases (sensitivity of 100% and specificity of 83%).

Conclusion: Our preliminary data indicate that most brain MRIs performed for routine evaluation of children with IGHD are not essential for establishing diagnosis. Only the children with extreme height deficit (≥2 SDS) and peak GH ≤6.5 µg/liter had pathological brain MRIs. Further studies with larger cohorts are needed in order to validate this revision of current protocols.

Volume 92

58th Annual ESPE meeting

Vienna, Austria
19 Sep 2019 - 21 Sep 2019

European Society for Paediatric Endocrinology 

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