The necessity of magnetic resonance imaging in the evaluation of pediatric growth hormone deficiency: Lessons from a large academic center,Growth Hormone and IGF Research

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The necessity of magnetic resonance imaging in the evaluation of pediatric growth hormone deficiency: Lessons from a large academic center
Growth Hormone and IGF Research ( IF 1.4 ) Pub Date : 2021-08-19 , DOI: 10.1016/j.ghir.2021.101427
Leena Mamilly ₁ , Amy L Pyle-Eilola ₂ , Monika Chaudhari ₁ , Rohan K Henry ₁

Affiliation

Background

Current guidelines indiscriminately recommend magnetic resonance imaging (MRI) of the pituitary gland in pediatric growth hormone deficiency (GHD). The relationship between abnormal MRI, most importantly a tumor, and peak GH levels is not well known.

Methods

In this retrospective chart review, pituitary MRI results of children, ages of 3–16 years with GHD were collected and divided into 3 groups according to peak stimulated GH levels; ≤5, 5–7.4 and 7.5–10 ng/mL, Groups A, B & C respectively. Clinical and MRI findings were compared between the groups.

Results

A total of 399 children were included. Abnormal MRI was found in 36.9% of group A subjects, compared to group B (16.7%) and group C (17.0%), both p values =0.0002. Children with multiple pituitary hormonal deficiencies (MPHD) had a higher rate of abnormalities than those with isolated GHD. Children with isolated GHD were more likely to have abnormal MRI with peak GH level < 5 ng/mL compared to those with levels, 5–7.4 & 7.5–10 ng/mL. 4 children in group A had a craniopharyngioma. ROC analysis comparing peak GH levels with abnormal MRI findings showed an area under the curve (AUC) of 0.614 and 0.728 for IGHD and MPHD, respectively.

Conclusion

Although abnormal MRI was found in all 3 study groups, it was more likely at GH level < 5 ng/mL and in children with MPHD. To avoid missing a tumor, the importance of imaging in children with GHD and peak GH levels <5 ng/mL cannot be overemphasized.

中文翻译：

磁共振成像在评估儿科生长激素缺乏症中的必要性：来自大型学术中心的经验教训

背景

目前的指南不加选择地推荐小儿生长激素缺乏症 (GHD) 垂体的磁共振成像 (MRI)。异常 MRI（最重要的是肿瘤）与峰值 GH 水平之间的关系尚不清楚。

方法

在本回顾性图表回顾中，收集了 3-16 岁 GHD 儿童的垂体 MRI 结果，并根据刺激的 GH 峰值水平分为 3 组；≤5、5–7.4 和 7.5–10 ng/mL，分别为 A、B 和 C 组。比较两组的临床和MRI结果。

结果

共纳入 399 名儿童。与 B 组 (16.7%) 和 C 组 (17.0%) 相比，36.9% 的 A 组受试者发现异常 MRI，两个p值 = 0.0002。患有多种垂体激素缺乏症 (MPHD) 的儿童的异常率高于孤立性 GHD 的儿童。与水平为 5-7.4 和 7.5-10 ng/mL 的儿童相比，孤立性 GHD 的儿童更可能出现 MRI 异常，峰值 GH 水平 < 5 ng/mL。A组4名儿童患有颅咽管瘤。ROC 分析比较峰值 GH 水平与异常 MRI 结果显示，IGHD 和 MPHD 的曲线下面积 (AUC) 分别为 0.614 和 0.728。