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Evaluation of thyrotrophic and lactotrophic reserves in patients with pituitary dwarfism with and without empty sella turcica

  • César Geremia ORCID logo EMAIL logo and Felipe Geremia ORCID logo
Published/Copyright: July 21, 2025
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 38 Issue 9

Abstract

Objectives

Empty sella turcica (ES) is commonly observed in idiopathic growth hormone deficiency (GHD) in children. This study aims to determine the frequency of ES in children with GHD, assess their pituitary thyroid-stimulating hormone (TSH) and prolactin (PRL) reserves using the thyrotropin-releasing hormone (TRH) stimulation test, and investigate whether ES is associated with a higher prevalence of combined pituitary hormonal deficiencies.

Methods

TSH and PRL pituitary reserves were assessed through the TRH stimulation test in 22 patients with ES and 31 without this finding (non-ES). All participants had childhood-onset GHD and underwent pituitary imaging, primarily by computed tomography (CT) Anti-thyroid peroxidase (anti-TPO) antibodies were measured in all patients with elevated basal TSH.

Results

Among 125 children diagnosed with GHD between 1988 and 1996, ES was identified in 29 cases (23 %). Fifty-three patients agreed to participate (86.8 % male), with ES present in 43.5 % of males and 28.6 % of females. No significant differences in TSH and PRL responses to TRH were observed between the ES and non-ES groups. Mildly elevated basal TSH was observed in 50 % of patients with ES and 55 % without ES, most of who tested negative for anti-TPO antibodies. Among patients with elevated basal TSH and hypothyroidism, the majority exhibited exaggerated or delayed TSH responses to TRH and elevated basal PRL, findings suggestive of hypothalamic dysfunction. Four patients presented combined GH, TSH, and PRL deficiencies.

Conclusions

ES is common in children with GHD but presents distinct features compared to adults. Central hypothyroidism (CeH) was observed in 45.6 % of patients with ES and 54.8 % without ES. Mild TSH elevation was frequent and rarely associated with anti-TPO antibodies, supporting the exclusion of primary hypothyroidism and suggesting underlying hypothalamic dysfunction. Subclinical hormonal abnormalities were also frequent among euthyroid patients. The TRH stimulation test proved valuable in distinguishing hypothalamic dysfunction from pituitary or primary hypothyroidism. Genetic testing for POU1F1 and PROP1 mutations may be warranted in selected cases with combined deficiencies.

Keywords: growth hormone deficiency; empty sella turcica; combined pituitary hormone deficiency; central hypothyroidism
Corresponding author: César Geremia, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil, E-mail:

Funding source: Fundo de Incentivo àPesquisa e Eventos of the Hospital de ClÃ-nicas de Porto Alegre

Acknowledgments

We extend our deepest gratitude to the late Dr. Regina Helena Elnecave for her invaluable insights and contributions to this study. We also thank the Research and Event Support Fund of the Hospital de Clínicas de Porto Alegre, Brazil, for their financial support in conducting this research.

  1. Research ethics: This study was approved by the Research Ethics Committee of Hospital de Clínicas de Porto Alegre, Brazil.

  2. Informed consent: Patients and their guardians were informed about the research and its objectives and provided written consent by signing an Informed Consent Form.

  3. Author contributions: César Geremia: conceptualization, data curation, investigation, methodology, project administration, writing-original draft preparation, writing-review, and editing. Felipe Geremia: Graphic design, formal analysis, visualization, writing-review, and editing. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Use of Large Language Models, AI and Machine Learning Tools: None declared.

  5. Conflict of interest: The authors state no conflict of interest.

  6. Research funding: The funding for this study was provided by the Fundo de Incentivo à Pesquisa e Eventos (Research and Events Incentive Fund) linked to the Post-Graduate Studies Group of the Hospital de Clínicas de Porto Alegre, Brazil.

  7. Data availability: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Received: 2025-02-17
Accepted: 2025-07-10
Published Online: 2025-07-21
Published in Print: 2025-09-25

© 2025 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/jpem-2025-0082
Keywords for this article
growth hormone deficiency; empty sella turcica; combined pituitary hormone deficiency; central hypothyroidism

Articles in the same Issue

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  2. Mini Review
  3. Transition of care from childhood/adolescence to adulthood in familial hypercholesterolemia
  4. Original Articles
  5. Performance of adult height prediction methods in 6 to 8-year-old girls with GnRH-dependent precocious puberty
  6. Height velocity in the detection of growth disorders reconsidered: a retrospective analysis of the DONALD study
  7. Differentiating transient and permanent congenital hypothyroidism: predictive clues from Istanbul, Türkiye
  8. Evaluation of thyrotrophic and lactotrophic reserves in patients with pituitary dwarfism with and without empty sella turcica
  9. Exploring the impact of androgen levels on depression and anxiety in adolescent females: a clinical perspective
  10. The diagnostic value of stimulated androgen ratios in 5-alpha reductase type 2 (SRD5A2) deficiency: a case series and review of the literature
  11. Prolonged symptom duration and the potential for gradual progression in pediatric adrenocortical tumors: observations from the MET studies
  12. Distinguishing organic from idiopathic central precocious puberty: clinical characteristics and predictive factors for organic etiology in a multicenter Italian cohort study
  13. Endocrinopathies associated with pediatric common variable immunodeficiency
  14. Genetic, neuroimaging, and clinical characteristics of a cohort of individuals with L-2-hydroxyglutaric aciduria from Türkiye
  15. Short Communications
  16. Stress hyperglycemia in pediatric patients as a risk factor for type 1 diabetes – a single center experience
  17. Observations of the effect of gonadotropin-releasing hormone analog treatment on psychosocial well-being in transgender youth and their caregivers – a pilot study
  18. Letter to the Editor
  19. GNB1 haploinsufficiency presents as monogenic obesity syndrome
  20. Case Reports
  21. Rare pediatric insulinoma case diagnosed by endoscopic ultrasonography: insights into endogenous hyperinsulinemic hypoglycemia
  22. Caudal epidural steroid injection as a novel therapy for treatment-induced neuropathy of diabetes in children: report of two cases
  23. A novel homozygous missense DNAJC3 variant in syndromic juvenile-onset diabetes
  24. 3-Hydroxy-3-methylglutaryl-coenzyme A lyase deficiency: case report of a child with rare HMGCL gene variants
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