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.
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.
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.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
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.
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