ESPE2021 ePoster Category 2 Growth hormone and IGFs (31 abstracts)
Pituitary gland volume measured by Magnetic Resonance Imaging as diagnostic predictor of persistent Childhood-onset growth hormone deficiency
Beatriz Corredor-Andres 1,2 , Sandra Walton-Betancourth 1,3 , Caroline Brain 1,4 , Gary Butler 1 , Peter Hindmarsh 1,4 & Mehul Dattani 1,4,5
1University College London Hospitals NHS Foundation Trust, London, United Kingdom; 2Hospital Universitario de Toledo, Toledo, Spain; 3Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom; 4Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; 7UCL Great Ormond Street Institute of Child Health, London, United Kingdom
Introduction: Pituitary imaging is important for the evaluation of hypothalamo-pituitary axis defects in patients diagnosed with childhood-onset growth hormone deficiency (CO-GHD). Published evidence shows that there is a close relationship between structural changes in the pituitary gland and growth hormone deficiency.
Aim: To evaluate the relationship between clinical, laboratory and magnetic resonance imaging of the pituitary gland in a cohort of CO-GHD patients during the transition period, and to assess the value of pituitary volume as a diagnostic predictor of persistent GHD.
Methods: Retrospective case review of patients diagnosed with CO-GHD referred to our adolescent unit between 2012 and 2020. Adult GHD (AGHD) was defined as a stimulated GH peak < 3 µg/l. Published normative data on pituitary diameters were used to calculate pituitary volumes.
Patients: The study included data from 102 individuals (75 males) diagnosed with CO-GHD (75 patients with Isolated growth hormone deficiency, IGHD; and 27 with multiple pituitary hormone deficiency, MPHD), who underwent retesting of GH reserve at 18.04 years of age (IQR: 17.1-19.1). Patients who had a history of head injuries or radiation exposure were not included. MRI findings were evaluated in 87 individuals.
Results: AGHD was confirmed in 49 individuals with IGHD (66%) and 23 with MPHD (85%), p: 0.015. In our cohort PG volume was negatively correlated with MPHD (p: 0.006) and persistence of growth hormone deficiency in adulthood (p: 0.024). Having an anatomically normal pituitary gland (PG), did not decrease the likelihood of being diagnosed with ADHD (Table 1). Multivariant analysis of logistic regression suggested that pituitary volume, CO-MPHD and IGF1 (SD) off GH therapy are good predictors of AGHD ([SE 88.5 %, SP 27.3%] p 0.02).
| MRI findings | Non AGHD | AGHD | P value |
| Pituitary volume (SD) | 0.3 ±1.28 | -0.47 ±1.36 | 0.024 |
| Anatomically normal pituitary gland | 56.7 % | 73.9% | 0.089 |
| Abnormal posterior pituitary gland (APP) | 20 % | 47.8 % | 0.009* |
| Combined Small anterior pituitary gland and abnormal posterior pituitary gland | 13.3 % | 55 % | 0.005* |
| Septo Optic Dysplasia | 11.53 % | 21.3 % | 0.28 |
| IGF-1 off treatment (SD) | 0.73 ±1.31 | -0.67 ±2.11 | 0.001* |
Conclusions: Measurement of pituitary gland volume by MRI combined with IGF-1 concentrations off GH treatment, could help clinicians to rationalise the extent of GH axis re-assessment in patients with IGHD/MPHD at transition.
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