Clinical and Biochemical Phenotype of Indian Children with Different Types of Idiopathic Growth Hormone Deficiency and their Association with Pituitary Height on MRI.

BACKGROUND AND OBJECTIVES: Differentiation of growth hormone deficiency (GHD) into various types has been made based on peak stimulated growth hormone levels and other hormone axis involvement. The data regarding how this classification is associated with variation in clinical and biochemical phenotype and how these findings associate with pituitary morphology remains sparse, especially in the Indian population. Therefore, we aimed to ascertain the differences in the pattern of auxological, clinical features including pituitary hypoplasia, and endocrinological profile among patients with severe GHD, partial GHD, and MPHD in the Indian population and to evaluate the association of pituitary height with various clinical and hormonal parameters. MATERIALS AND METHODS: We conducted a cross-sectional study in 100 patients with idiopathic GHD. Patients were grouped into severe GHD, partial GHD, and MPHD to observe the differences in clinical, biochemical, and MRI findings. The pituitary height findings were correlated clinical and biochemical presentation. RESULTS: MPHD subjects had a significantly higher frequency of breech delivery, neonatal jaundice, neonatal hypoglycemia, and micropenis. A significant difference was observed in the chronological age, bone age retardation (CA-BA), height SDS, weight SDS, peak GH response, IGF-1, IGF-1 SDS, and prevalence of pituitary hypoplasia, pituitary height, and pituitary height SDS among these three groups. In the composite population of GHD, pituitary height SDS was correlated with peak GH, basal IGF-I SDS, and body height SDS. CONCLUSION: The clinical and biochemical phenotype differs significantly among the various types of GHD. Pituitary height correlates with these findings and is helpful in further assessment of these patients.

Quantitative parameters for diagnosis of idiopathic intracranial hypertension on brain MRI.

PURPOSE: Aim of this study was to develop quantitative parameters for diagnosing Idiopathic Intracranial Hypertension (IIH) using brain MRI scans. METHODS: This is a case control study with 48 cases and 192 matched controls. Optic nerve diameter (OND), Pituitary height (PH), Meckel's cave diameter (MCD), and Neck fat thickness (NFT) were measured for both groups. Consequently, means were obtained for the different parameters in both groups with subsequent establishment of best cutoffs using Receiver Operator Curve (ROC) analysis. RESULTS: For IIH patients the means of OND, PH, MCD, and NFT were 6.2 mm, 3.9 mm, 5 mm, 1.4 cm, respectively while for controls the means were 4.6 mm, 4.5 mm, 4.3 mm, and 0.8 cm with statistical significance between the two groups. ROC analysis showed the cutoff points with best accuracy for the above parameters in diagnosing IIH to be 5.4 mm for OND with sensitivity of 0.77 and specificity of 0.85 representing high accuracy, while for PH a cutoff point of 3 mm showed low accuracy with sensitivity of 0.54 and specificity of 0.7, and a MCD cutoff of 4.5 mm also showed low accuracy with sensitivity of 0.6 and specificity of 0.59, meanwhile a cutoff point of 1.1 cm for NFT was moderately accurate with sensitivity of 0.70 and specificity of 0.81. CONCLUSION: Statistical difference in the means for OND, PH, MCD, and NFT between IIH patients and controls is established. Also, we provide cut off points for these parameters to diagnose IIH on brain MRI.

A novel diagnostic tool for the evaluation of hypothalamic-pituitary region and diagnosis of growth hormone deficiency: pons ratio.

Backgrounds Limitations in the evaluation of the pituitary size and changes according to pubertal status make its validity questionable. Recently, in a small-scale study, pons ratio (PR) has been suggested as a more sensitive tool for diagnosis and etiological evaluation of growth hormone deficiency (GHD). The aim of the study is to evaluate the diagnostic value of PR in the diagnosis of GHD. Methods We retrospectively evaluated the pituitary magnetic resonance imaging (MRI) of 133 patients with a diagnosis of GHD. Primary axis (PA) was assigned as a line crossing the mid-sagittal dorsum sella and fourth ventricle. PR was defined as the pons height above the PA divided by total pons height. The PR of patients with GHD was compared to subjects without GHD. Results Study included 133 patients with GHD and 47 controls. In total, 121 (91%) patients had isolated GHD and 12 (9%) patients had multiple pituitary hormone deficiency. The PR of the patient group (mean: 0.32 ± 0.89; range: 0.14-0.63) was significantly higher than controls (mean: 0.26 ± 0.067; range 0.19-0.44) (p: 0.000). The optimal cut-off value of PR for GHD diagnosis was 0.27 (sensitivity 71% specificity 56%). There was a negative correlation between anterior pituitary height (APH)-SDS and PR (p: 0.002; r: -0.27). APH was increased, but PR remained unchanged in pubertal patients (p: 0.089). Conclusions PR measurement is a noninvasive, practical method with a cost-benefit clinical value. As it is not affected by pubertal status, PR is potentially a more sensitive tool for evaluation of pituitary gland in GHD patients compared to APH.

Variant sella morphology and pituitary gland height in adult patients with Chiari II malformation: potential pitfall in MRI evaluation.

PURPOSE: To systematically evaluate the sella morphology and pituitary gland height on brain MRI of Chiari II malformation (C2M) patients to understand the observed high incidence of apparent enlargement of the pituitary gland. METHODS: Brain MRIs of C2M patients at a single tertiary care adult institution were retrospectively reviewed. We also evaluated two age and gender-matched control groups-patients with normal brain MRI (C1 group) and chronic ventricular shunts (C2 group). The heights of tuberculum sella, dorsum sella, and pituitary gland were measured and compared. The presence or absence of dural thickening was noted. RESULTS: 21 patients were included in each group. In C2M group, a pituitary adenoma was suggested on 24% of the MRIs. The dorsum sella was significantly smaller in the C2M group (4.8 mm) compared to both the C1 group (7.4 mm, p < 0.001) and the C2 group (7.1 mm, p < 0.001). The pituitary gland was also larger in the cranial-caudal dimension in C2M group (8.6 mm) as compared to both the C1 group (6.6 mm, p < 0.01) and the C2 group (6.0 mm, p < 0.001). One C2M patient with a pituitary gland<10 mm was suggested to have a pituitary adenoma on outside MRI, although a normal pituitary gland was seen on pathology. CONCLUSION: C2M patients have shallow sella which can accentuate the pituitary gland height. The mean pituitary height was larger in C2M patients, but no functional pituitary pathology was present. It is important to consider sella morphology when evaluating the pituitary gland of C2M patients to avoid unnecessary medical and surgical interventions.

The trade-off between the olfactory bulb and eyeball volume in precocious puberty.

Background The olfactory bulb (OB) and eyeball size change depending on age and puberty. There is a well-established trade-off between sensory structures of the brain such as the eye and the olfactory bulb that depend on environmental circumstances in the evolutionary history of animals. The aim of this study was to developmentally investigate the potential reciprocal changes between OB and eyeball volumes (EV) in girls with precocious puberty (PP). Methods A total of 148 girls aged between 5 and 8 years (63 PP, 85 healthy) were included in the study. Exclusion criteria: Cases of anosmia/hyposmia, neurodegenerative disorder, refractive errors and trauma. The pituitary height (PH), EV and OB volumes were measured on segmentation of a magnetic resonance image (MRI) slice using manual countering. The corrected measurements by body surface were used in all statistical analyses. Results In girls with PP, the means of the OB volume and PH were larger (71.11 ± 20.64 mL) and higher (4.62 ± 1.18 mm), respectively, while the mean of EVs was smaller (11.24 ± 2.62 cm3) (p = 0.000). Cut-off values were 62.27 mL, 10.7 cm3 and 4.71 mm for OB volume, EV and PH, respectively. While negative correlations were found between OB volume-EV and EV-PH (r63 = -0.224, p = 0.001 and r63 = -0.116, p = 0.001, respectively), OB volume was positively correlated with PH (r63 = 0.578, p = 0.001). Conclusions The present study demonstrates that girls with PP have significantly larger OB volume, but smaller EV, and there is negative correlation between the two structures. These results indicate that there is trade-off between anatomical dimensions of OB and eyeball in favor of OB in PP girls.

Study of pituitary glands in normal adults by high-resolution MRI / 上海交通大学学报（医学版）

Objective ·To study changes of morphological characteristics of pituitary glands Objective · To study changes of morphological characteristics of pituitary glandsin normal adults by high-resolution magnetic resonance imaging (MRI). Methods · A total of 245 healthy adults were scanned by 3.0T MRI to measurewidths,lengths,heights and volumes of pituitary glands and observe pituitary gland morphology. Results · The average height of pituitary was (5.47±1.33) mm inmales and (6.06±1.32) mm in females; the average volume of pituitary was (614.07±125.52) mm3 in males and (660.00±117.35) mm3 in females. The difference betweenthe genders was statistically significant (P<0.01). The pituitary height was positively related to the pituitary volume (r=0.829,P<0.01). Except the pituitary lengths, there was statistically significance in the pituitary widths, heights and volumes among different age groups (P<0.05), and all of them were negatively correlated with age (P<0.01). Conclusion · The pituitary heights and volumes peak in the 18-29 age group in adults and tend to decline with increased age. In female subjects, however, there is a tendency of pituitary heights and volumes to increaseagain in the 50-59 age group. The average height and volume of female pituitary glands are significantly greater than those of males.