Likelihood of persistent GH deficiency into late adolescence: relationship to the presence of an ectopic or normally sited posterior pituitary gland

Abstract

It is important to document GH status at the end of growth, even if there is a structural abnormality of the hypothalamic-pituitary axis. The presence of an EPP compared to an NPP increases the likelihood of persistent GHD by 26%. As all EPP patients had a peak GH level of <10 microg/l, the cut-off for persistent GHD in late adolescence may need to be revised.

Magnetic resonance imaging of CNS in 15 043 children with GH deficiency in KIGS (Pfizer International Growth Database)

“…The frequency of these radiological findings and their endocrine spectrum is variable. In particular, MPHD is more frequently associated with ectopic posterior pituitary and anterior pituitary hypoplasia than isolated GHD (2,3,5,13,14,15,17,18,20,21,22,23,24,25). The variability between different studies can be ascribed to the degree of restriction in the studies' diagnostic criteria, to the diagnostic limits of GHD itself (transitory deficits, recovery, false positives, etc.)…”

“…In fact, the neuroimaging findings in GHD mainly include the following: first, normal or hypoplastic pituitary gland/empty sella (ES) without anatomical abnormalities of the hypothalamus or pituitary stalk and secondly, moderate-to-severe (pituitary height %3 mm) hypoplastic pituitary gland with ectopic posterior pituitary located anywhere from the median eminence to the distal stalk (1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25). Isolated GHD is more commonly observed in the first category while multiple pituitary hormone deficiencies (MPHD) occur more frequently in the second.…”

Associations between Pituitary Imaging Abnormalities and Clinical and Biochemical Phenotypes in Children with Congenital Growth Hormone Deficiency: Data from an International Observational Study

“…MRI may reveal brain mid-line defects, such as septo-optic dysplasia (SOD), pituitary stalk interruption syndrome (also termed ‘the classic triad') [9], ectopic posterior pituitary (EPP) and pituitary aplasia/hypoplasia. Small studies have examined MRI in relation to specific clinical and hormonal outcomes [6,9,10,11,12] and genetic defects [13,14,15]. These studies suggest that certain MRI findings may be associated with specific genetic abnormalities and can identify patients who have a greater likelihood of developing MPHD or having GHD that will persist into adulthood.…”

“…However, a complex genetic program governs pituitary gland development and differentiation, and multiple pituitary hormone deficiencies (MPHD) may develop over time [3,4,5]. In addition, some patients who have GHD diagnosed during childhood are not GH deficient when retested as adults [6]. Consequently, new insights are needed regarding which patients will develop other pituitary deficiencies and which patients will remain GH deficient in adulthood.…”

The Prognostic Value of The Growth Hormone Secretion Stimulating Tests withl-dopa and clonidine in Children with Growth Hormone Deficiency Treated with Recombinant Human Growth Hormone in Western Pomeranian Region

“…Rozpoznanie niedoboru GH w okresie dzieciń-stwa nie musi być jednoznaczne z jego trwałością w późniejszym wieku [31]. Większe wydzielanie hormonu wzrostu w retestingu może wiązać się z fizjologicznym zwiększeniem wydzielania tego hormonu w okresie pokwitania jak również z lepszą kontrolą podwzgórza, którą dziecko uzyskuje po osiągnięciu dojrzałości płciowej [18,32,33]. Niektórzy autorzy uważają jednak, że stwierdzana w retestingu normalizacja wydzielania hormonu wzrostu może świadczyć o niedoskonałości testów diagnostycznych [34].…”