Startseite Medizin Pituitary volume in children with growth hormone deficiency, idiopathic short stature and controls
Artikel
Lizenziert
Nicht lizenziert Erfordert eine Authentifizierung

Pituitary volume in children with growth hormone deficiency, idiopathic short stature and controls

  • Marion Kessler , Michael Tenner , Michael Frey und Richard Noto EMAIL logo
Veröffentlicht/Copyright: 6. Oktober 2016

Abstract

Background:

The objective of the study was to describe the pituitary volume (PV) in pediatric patients with isolated growth hormone deficiency (IGHD), idiopathic short stature (ISS) and normal controls.

Methods:

Sixty-nine patients (57 male, 12 female), with a mean age of 11.9 (±2.0), were determined to have IGHD. ISS was identified in 29 patients (20 male, 9 female), with a mean age of 12.7 (±3.7). Sixty-six controls (28 female, 38 male), mean age 9.8 (±4.7) were also included. Three-dimensional (3D) magnetic resonance images with contrast were obtained to accurately measure PV.

Results:

There was a significant difference in the mean PV among the three groups. The IGHD patients had a mean PV 230.8 (±89.6), for ISS patients it was 286.8 (±108.2) and for controls it was 343.7 (±145.9) (p<0.001). There was a normal increase in PV with age in the ISS patients and controls, but a minimal increase in the IGHD patients.

Conclusions:

Those patients with isolated GHD have the greatest reduction in PV compared to controls and the patients with ISS fall in between. We speculate that a possible cause for the slowed growth in some ISS patients might be related to diminished chronic secretion of growth hormone over time, albeit having adequate pituitary reserves to respond acutely to GH stimulation. Thus, what was called neurosecretory GHD in the past, might, in some patients, be relative pituitary hypoplasia and resultant diminished growth hormone secretion. Thus, PV determinations by magnetic resonance imaging (MRI) could assist in the diagnostic evaluation of the slowly growing child.


Corresponding author: Richard Noto, MD, Diabetes and Endocrine Center for Children and Young Adults, 755 North Broadway, Suite 400, Sleepy Hollow, NY 10591, USA, Phone: +914-366-3400, Fax: +914-366-3407

Acknowledgments

We thank all the many summer research students who assisted in retrieving and analyzing patient data. We also thank our research coordinator Jane Torres for her invaluable help and assistance. We thank Dr. Jason Kessler, MD, Assistant Professor of Medicine at New York University, New York, NY for his help with statistical analysis.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission. Marion Kessler: Dr. Kessler analyzed and collated the data, drafted the initial manuscript and approved the final manuscript submitted. Michael Tenner: Dr. Tenner helped conceptualize and design the study, interpreted each MRI and measured each pituitary volume. He also reviewed and helped revise the manuscript and approved the final manuscript as submitted. Michael Frey: Dr. Frey helped conceptualize and design the study and ran the assays for the growth hormone levels. Richard Noto: Dr. Noto helped conceptualize and design the study, participated in analyzing and collating data, reviewed and revised the manuscript and approved the final submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Wilson T, Rose S, Cohen P, Rogol AD, Backeljauw P, et al. Update of guidelines for the use of growth hormone in children: the Lawson Wilkins pediatric endocrinology society drug and therapeutics committee. J Pediatr 2003;143:415–21.10.1067/S0022-3476(03)00246-4Suche in Google Scholar

2. Badaru A, Wilson DM. Alternatives to growth hormone stimulation testing in children. Trends Endocrinol Metab 2004;15:252–8.10.1016/j.tem.2004.06.004Suche in Google Scholar

3. Loche S, Guzetti C, Pilia S, Ibba A, Civolani P, et al. Effect of body mass index on the growth hormone response to clonidine stimulation testing in children with short stature. Clin Endocrinol 2011;74:726–31.10.1111/j.1365-2265.2011.03988.xSuche in Google Scholar

4. Stanley T, Levitsky L, Grinspoon S, Misra M. Effect of body mass index on peak growth hormone response to provocative testing in children with short stature. J Clin Endocrinol Metab 2009;94:4875.10.1210/jc.2009-1369Suche in Google Scholar

5. Carmichael JD, Danoff A. GH peak response to GHRH-arginine relationship to insulin resistance and other cardiovascular risk factors in a population of adults aged 50 to 90. Clin Endocrinol 2006;65:169–77.10.1111/j.1365-2265.2006.02569.xSuche in Google Scholar

6. Ghigo E, Procopio M. Arginine potentiates but does not restore the blunted growth hormone response to growth hormone releasing hormone in obesity. Metabolism 1992;41:560–3.10.1016/0026-0495(92)90220-5Suche in Google Scholar

7. Kopelman PG, Noonan K. Impaired growth hormone response to growth hormone releasing factor and insulin-hypoglycemia in obesity. Clin Endocrinol 1985;23:87–94.10.1111/j.1365-2265.1985.tb00187.xSuche in Google Scholar PubMed

8. Willliams T, Berelowitz M. Impaired growth hormone responses to growth hormone-releasing factor in obesity. A pituitary defect reversed with weight reduction. N Engl J Med 1984;311:1403–7.10.1056/NEJM198411293112203Suche in Google Scholar PubMed

9. Tassoni P. Variability of growth hormone response to pharmacological and sleep tests performed twice in short children. J Clin Endocrinol Metab 1990;71:230–4.10.1210/jcem-71-1-230Suche in Google Scholar PubMed

10. Cacciari E. Value and limits of pharmacological and physiological tests to diagnose growth hormone (GH) deficiency and predict therapy response: first and second retesting during replacement therapy of patients defined as GH deficient. J Clin Endocrinol Metab 1994;79:1663–9.Suche in Google Scholar

11. Maghnie M. Relationship between the morphological evaluation of the pituitary and the growth hormone (GH) response to GH-releasing hormone plus arginine in children and adults with congenital hypopituitarism. J Clin Endocrinol Metab 2001;86:1574–9.Suche in Google Scholar

12. Chesover AD, Dattani MT. Evaluation of GH stimulation testing in Children. Clin Endocrinol 2016;84:708–14.10.1111/cen.13035Suche in Google Scholar PubMed

13. Cohen P, Rogol A, Deal CL, Saenger P, Reiter EO, et al. Consensus statement on the diagnosis and treatment of children with idiopathic short stature. A summary of the GH research society, The Lawson Wilkins Pediatic Endocrine Society and the European Society for Paediatric Endocrine Workshop. J Clin Endocrinol Metab 2008;93:4210–7.10.1210/jc.2008-0509Suche in Google Scholar

14. Spiliotis BE, August GP, Hung W, Sonis W, Mendelson W, et al. Growth hormone neurosecretory dysfunction. A treatable cause of short stature. J Am Med Assoc 1984;251:2223–30.10.1001/jama.251.17.2223Suche in Google Scholar

15. Zadik Z, Chalew S, Raiti S, Kowarski AA. Do short children secrete insufficient growth hormone? Pediatrics 1985;76:355–60.10.1542/peds.76.3.355Suche in Google Scholar

16. Bercu BB, Diamond FB. Growth hormone neurosecretory dysfunction. Clin Endocrinol Metab 1986;15:537–90.10.1016/S0300-595X(86)80010-XSuche in Google Scholar

17. Nagel B, Palmbach M, Peterson D, Ranke MB. Magnetic resonance images of 91 children with different causes of short stature: pituitary size reflects growth hormone secretion. Eur J Pediatr 1997;156:758–63.10.1007/s004310050707Suche in Google Scholar PubMed

18. Iorgi N, Allegri A, Napoli F, Bertelli E, Olivieri I, et al. The use of neuroimaging for assessing disorders of pituitary development. Clin Endocrinol 2012;76:161–76.10.1111/j.1365-2265.2011.04238.xSuche in Google Scholar PubMed

19. Arends N, Lip W, Robben G, Hokken-Koelega AC. MRI findings of the pituitary gland in short children born small for gestational age (SGA) in comparison with growth hormone-deficient (GHD) children and children with normal stature. Clin Endocrinol 2002;57:719–24.10.1046/j.1365-2265.2002.01605.xSuche in Google Scholar PubMed

20. Maghnie M, Ghirardello S, Genovese E. Magnetic resonance imaging of the hypothalamus pituitary unit in children suspected of hypopituitarism: who, how and when to investigate. J Endocrinol Invest 2003;27:496–509.10.1007/BF03345298Suche in Google Scholar PubMed

21. Bordallo M, Tellerman L. Bosignoli R, Oliveira FF, Gazzola FM, et al. Neuroradiological investigation in patients with idiopathic growth hormone deficiency. J Pediatr 2004;80:223–7.10.2223/1187Suche in Google Scholar

22. Bozzola M, Mengarda F, Sartirana P, Tato L, Chaussain JL. Long-term follow-up evaluation of magnetic resonance imaging in the prognosis of permanent GH deficiency. Eur J Endocrinol 2000;143:493–6.10.1530/eje.0.1430493Suche in Google Scholar PubMed

23. Maghnie M, Lindberg A, Koltowska-Haggstrom M, Ranke MD. Magnetic resonance imaging of CNS in 15,043 children with GH deficiency in KIGS (Pfizer International Growth Database). Eur J Endocrinol 2013;168:211–7.10.1530/EJE-12-0801Suche in Google Scholar PubMed

24. DiChiro G, Nelson KB. The volume of the sella turcica. Am J Roent Genol Radium Ther Nucl Med 1962;87:989–1008.Suche in Google Scholar

25. Siemens immulite. Siemens Healthcare Diagnostics Inc. Los Angeles, CA, USA.Suche in Google Scholar

26. Olivieri H, Salvatori R, Kraus M, Oliveira CR, Silva PR, et al. Magnetic resonance imaging study of pituitary morphology in subjects homozygous and heterozygous for a null mutation of the GHRH receptor gene. Eur J Endocrinol 2003;148:427–32.10.1530/eje.0.1480427Suche in Google Scholar PubMed

27. Takano K, Utsunomiya H, Ono H, Ohfu M, Okazaki M. Normal development of the pituitary gland: assessment with three-dimensional MR volumetry. Am J Neuroradiol 1999;20:312–5.Suche in Google Scholar

28. Marziali S, Guadiello F, Bozzao A, Scirè G, Ferone E, et al. Evaluation of anterior pituitary gland volume in childhood using 3 – dimensional MRI. Pediatr Radiol 2004;34:547–51.10.1007/s00247-004-1208-6Suche in Google Scholar PubMed

29. Fink A, Vidmar S, Kumbla S, Pedreira CC, Kanumakala S, et al. Age-related pituitary volumes in prepubertal children with normal endocrine function: volumetric magnetic resonance data. J Clin Endocrinol Metab 2005;90:3274–8.10.1210/jc.2004-1558Suche in Google Scholar PubMed

30. Zadik Z, Chalew S, Raiti S, Kowarski AA. Do short children secrete insufficient growth hormone? Pediatrics 1985;76:355–9.10.1542/peds.76.3.355Suche in Google Scholar

31. Ricotta D, Kamolika D, Mautner D, Himel A, Elpenard C, et al. Correlation of pituitary volume (PV), IGF-1 and IGFBP-3 in growth hormone deficient (GHD) and idiopathic short stature (ISS) adolescent subjects (ALD) abstract presented at the 88th annual Endocrine Society Meeting. 2006.Suche in Google Scholar

Received: 2015-10-10
Accepted: 2016-8-29
Published Online: 2016-10-6
Published in Print: 2016-10-1

©2016 Walter de Gruyter GmbH, Berlin/Boston

Artikel in diesem Heft

  1. Frontmatter
  2. Review
  3. An update on thyroid-associated ophthalmopathy in children and adolescents
  4. Mini Review
  5. Systematic review and meta-analysis of the association between mumps during childhood and risk of type 1 diabetes mellitus
  6. Original Articles
  7. Glycemic variability predicts inflammation in adolescents with type 1 diabetes
  8. Prevalence and risk factors for diabetic retinopathy in a hospital-based population of Australian children and adolescents with type 1 diabetes
  9. One month of omega-3 fatty acid supplementation improves lipid profiles, glucose levels and blood pressure in overweight schoolchildren with metabolic syndrome
  10. The outcome of seven patients with hereditary tyrosinemia type 1
  11. Increased oxidative stress parameters in children with moderate iodine deficiency
  12. Relationship between 25(OH)D levels and circulating lipids in African American adolescents
  13. Endoglin and obestatin levels, cardiometabolic risk factors and subclinical atherosclerosis in children aged 10–18 years
  14. Lipoprotein-associated phospholipase A2 activity and low-density lipoprotein subfractions after a 2-year treatment with atorvastatin in adolescents with type 1 diabetes
  15. Genetic characteristics and long-term follow-up of 11 patients with congenital hyperinsulinism followed in a single center
  16. Pituitary volume in children with growth hormone deficiency, idiopathic short stature and controls
  17. Case Reports
  18. A novel insulin receptor mutation in an adolescent with acanthosis nigricans and hyperandrogenism
  19. Primary hyperparathyroidism may masquerade as rickets-osteomalacia in vitamin D replete children
  20. Co-existence of phenylketonuria either with maple syrup urine disease or Sandhoff disease in two patients from Iran: emphasizing the role of consanguinity
  21. Severe malnutrition causing superior mesenteric artery syndrome in an adolescent with Triple A syndrome
  22. Solving a case of allelic dropout in the GNPTAB gene: implications in the molecular diagnosis of mucolipidosis type III alpha/beta
Heruntergeladen am 18.1.2026 von https://www.degruyterbrill.com/document/doi/10.1515/jpem-2015-0404/pdf
Button zum nach oben scrollen