ESPE Abstracts

Background: The precise growth hormone (GH) cut-off value for diagnosing growth hormone deficiency (GHD) in children is a subject of ongoing debate. With GH provocative tests typically using cut-offs between 4.7 and 6.5 µg/L, the traditional threshold of <10 µg/L is being reconsidered in favor of <7 µg/L due to advancements in GH assay standardization. Magnetic resonance imaging (MRI) of the pituitary gland is a crucial diagnostic tool, although the prevalence of MRI abnormalities in GHD patients varies widely across studies.

Methods: We conducted a retrospective review of the radiological, clinical, and laboratory records of 43 short stature children (aged 5–11 years, mean 7.2 ± 2.3 years) with confirmed GHD (Peak GH response to clonidine and glucagon provocation <7 µg/L), who underwent brain MRI. Patients were categorized into two groups based on their peak GH response to provocation: Group 1 (<5 µg/L, n = 34) and Group 2 (>5 and <7 µg/L, n = 9).

Results: MRI evaluations revealed pituitary gland abnormalities in 10 out of 34 children in Group 1 and 2 out of 9 children in Group 2. The findings indicate that MRI evaluation of the hypothalamic-pituitary axis is warranted in short children with peak GH responses >5 and <7 µg/L, as it effectively reveals pituitary morphological characteristics and aids in the diagnosis of GHD. • MRI abnormalities included: • 6 Small/ hypoplastic pituitary gland for patient's age, 1 Partial empty sella with the pituitary gland small and flattened, 1 Caudally located sella tissue, 1 Non-enhancing asymmetrical thickening of the left pre-chiasmatic optic nerve, 1 small anterior pituitary gland, with delayed myelination and Chairi type 1 malformation, 1 Persistent type II craniopharyngeal canal, as described, with inferior descent and partial herniation of the anterior lobe of the pituitary gland and 1 Ectopic posterior pituitary with reduced caliber of the pituitary infundibulum.

Conclusion: Our study supports the use of MRI for the pituitary gland in the diagnostic evaluation of short-stature children with peak GH levels between 5 and 7 µg/L. MRI findings can contribute valuable diagnostic information in patients with lower peak GH levels, suggesting a broader application for MRI in the assessment of GHD.