Brain MRIs may be of low value in most children diagnosed with isolated growth hormone deficiency

Abstract

Objectives Brain MRIs are considered essential in the evaluation of children diagnosed with growth hormone deficiency (GHD), but there is uncertainty about the appropriate cut-off for diagnosis of GHD and little data about the yield of significant abnormal findings in patients with peak growth hormone (GH) of 7–10 ng/mL. We aimed to assess the frequency of pathogenic MRIs and associated risk factors in relation to peak GH concentrations. Methods In this retrospective multicenter study, charts of patients diagnosed with GHD who subsequently had a brain MRI were reviewed. MRIs findings were categorized as normal, incidental, of uncertain significance, or pathogenic (pituitary hypoplasia, small stalk and/or ectopic posterior pituitary and tumors). Charges for brain MRIs and sedation were collected. Results In 499 patients, 68.1% had normal MRIs, 18.2% had incidental findings, 6.6% had uncertain findings, and 7.0% had pathogenic MRIs. Those with peak GH<3 ng/mL had the highest frequency of pathogenic MRIs (23%). Only three of 194 patients (1.5%) with peak GH 7–10 ng/mL had pathogenic MRIs, none of which altered management. Two patients (0.4%) with central hypothyroidism and peak GH<4 ng/mL had craniopharyngioma. Conclusions Pathogenic MRIs were uncommon in patients diagnosed with GHD except in the group with peak GH<3 ng/mL. There was a high frequency of incidental findings which often resulted in referrals to neurosurgery and repeat MRIs. Given the high cost of brain MRIs, their routine use in patients diagnosed with isolated GHD, especially patients with peak GH of 7–10 ng/mL, should be reconsidered.

Is Gadolinium Contrast Necessary for Pituitary MRI in the Evaluation of Pediatric Short Stature and Growth Hormone Deficiency?

“…To our knowledge, this is the first study to examine the utility of MRI contrast material in the evaluation of pediatric short stature and/or isolated GHD. Our study identified a low incidence of pituitary and suprasellar abnormalities in these children, which is consistent with findings from prior studies [3,20]. The abnormalities found in our study are mainly developmental anomalies of the gland and congenital cysts, with no pituitary adenomas or suprasellar masses identified.…”

Intracranial Pathologies and Endocrine Results: Single Pediatric Endocrinology Center Experience

“…Also, there were no cases of pineal gland cysts or hamartoma. Pituitary and brain MRI findings are generally normal in isolated GHD cases, except in those with severe GHD (peak GH<3 ng/mL) (30). A study in 2019 evaluating brain MRI findings in isolated GHD mostly reported normal pituitary findings (67.5%).…”