The evolution of pituitary cysts in growth hormone-treated children

Matthew D. Krasnow; Nicholas A. Krasnow; Liam McGuirk; Tara P. Patale; Sarah Manely; Emily Sayegh; Benjamin Epstein; Sarriyah A. Hanif; Shilpa Mehta; Michael Tenner; Javin Schefflein; Hasit Mehta; Richard A. Noto

doi:10.1515/jpem-2022-0333

Article

The evolution of pituitary cysts in growth hormone-treated children

Matthew D. Krasnow , Nicholas A. Krasnow , Liam McGuirk , Tara P. Patale , Sarah Manely , Emily Sayegh , Benjamin Epstein , Sarriyah A. Hanif , Shilpa Mehta , Michael Tenner , Javin Schefflein , Hasit Mehta and Richard A. Noto

Published/Copyright: November 18, 2022

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 36 Issue 1

Abstract

Objectives

We have previously shown that pituitary cysts may affect growth hormone secretion. This study sought to determine cyst evolution during growth hormone treatment in children.

Methods

Forty-nine patients with short stature, a pituitary cyst, and at least two brain MRI scans were included. The percent of the pituitary gland occupied by the cyst (POGO) was calculated, and a cyst with a POGO of ≤15% was considered small, while a POGO >15% was considered large.

Results

Thirty-five cysts were small, and 14 were large. Five of the 35 small cysts grew into large cysts, while 6 of the 14 large cysts shrunk into small cysts. Of 4 cysts that fluctuated between large and small, 3 presented as large and 1 as small. Small cysts experienced greater change in cyst volume (CV) (mean=61.5%) than large cysts (mean=−0.4%). However, large cysts had a greater net change in CV (mean=44.2 mm³) than small cysts (mean=21.0 mm³). Older patients had significantly larger mean pituitary volume than younger patients (435.4 mm³ vs. 317.9 mm³) and significantly larger mean CV than younger patients (77.4 mm³vs. 45.2 mm³), but there was no significant difference in POGO between groups.

Conclusions

Pituitary cyst size can vary greatly over time. Determination of POGO over time is a useful marker for determining the possibility of a pathologic effect on pituitary function since it factors both cyst and gland volume. Large cysts should be monitored closely, given their extreme, erratic behavior.

Keywords: growth hormone deficiency; growth hormone therapy; idiopathic short stature; magnetic resonance imaging; pituitary cyst; pituitary incidentaloma

Corresponding author: Shilpa Mehta, MD, Diabetes and Endocrine Center for Children and Young Adults, Department of Pediatrics, Division of Pediatric Endocrinology, New York Medical College, 755 North Broadway, Suite 400, Sleepy Hollow, Valhalla, NY 10591, USA, Phone: +1 914 366 3400, Fax: +1 914 366 3407, E-mail: mdkrasnow@gmail.com

Acknowledgments

We thank all the summer research students who assisted in retrieving and analyzing patient data. We also thank our research coordinator Jane Torres for her invaluable assistance.

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: The requirement for informed consent was waived by the institutional review board of our institution due to the minimal concern, protection, and de-identification of entirely retrospective data.
Ethical approval: The research related to human use has complied with all the relevant national regulations and institutional policies, is in accordance with the tenets of the Helsinki Declaration, and has been approved by the Institutional Review Board of New York Medical College.

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Received: 2022-07-01

Accepted: 2022-11-01

Published Online: 2022-11-18

Published in Print: 2023-01-27

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Articles in the same Issue

https://doi.org/10.1515/jpem-2022-0333

Keywords for this article

growth hormone deficiency; growth hormone therapy; idiopathic short stature; magnetic resonance imaging; pituitary cyst; pituitary incidentaloma