PMID- 11154153
OWN - NLM
STAT- MEDLINE
DCOM- 20010308
LR  - 20191210
IS  - 0334-018X (Print)
IS  - 0334-018X (Linking)
VI  - 13
IP  - 9
DP  - 2000 Nov-Dec
TI  - Magnetic resonance imaging of the hypothalamic-pituitary axis in the diagnosis of 
      growth hormone deficiency.
PG  - 1577-83
AB  - In order to investigate the relationship between pituitary appearance and the 
      diagnosis of growth hormone deficiency (GHD), we have assessed magnetic resonance 
      imaging (MRI) scans and GH status during provocation tests in 110 patients (78 
      males; median age 9.8, range 0.1-20 yr), evaluated for possible GH disorders. On 
      the basis of pituitary function tests, patients were divided into GH deficient 
      (GH peak < 15 mIU/l [5.8 ng/ml]) (n = 82) or GH sufficient (GH peak > 15 mIU/l) 
      (n = 28). The former were further divided into those with multiple hormone 
      deficits (MPHD) (n = 19) or isolated GHD - severe IGHD (peak GH < 8 mIU/l [3.1 
      ng/ml]) or partial IGHD (8-15 mIU/l). The appearance of the 
      hypothalamic-pituitary (H-P) axis was classified as: (1) normal, (2) isolated 
      hypoplastic stalk (HPS), (3) isolated hypoplastic anterior lobe (HPAL) (PHT SDS < 
      -2.0), (4) HPS + HPAL or (5) ectopic posterior lobe (EPL). The last two were 
      considered severe abnormalities. PHT SDS (mean +/- SD -2.0 +/- 2.2) was 
      correlated to log peak GH levels in the whole group (r = 0.45; p < 0.0001) and in 
      the GHD group (r = 0.39; p < 0.0001). Sixty-five out of 82 in the GHD group had a 
      H-P axis abnormality (45 severe abnormalities), while 13 out of the 28 patients 
      in the GH sufficient group also had an abnormality (3 severe, but none with an 
      EPL). All patients with MPHD had a MRI abnormality, most commonly an EPL (79%). 
      Thus the presence of any MRI abnormality as a marker for GHD would generate a 
      sensitivity of 79%, but a specificity of only 54%, indicating that this could not 
      be used to confirm GHD. However, the presence of either an EPL or HPS + HPAL on 
      MRI is highly specific (100% and 89% respectively) and predictive of GHD 
      (positive predictive value 100% and 79% respectively), indicating that these 
      abnormalities provide confirmation of the diagnosis. We recommend that if 
      clinical, auxological and biochemical data indicate a diagnosis of GHD, then a 
      MRI scan should be undertaken to define the pituitary anatomy and to help confirm 
      the diagnosis.
FAU - Tillmann, V
AU  - Tillmann V
AD  - Department of Endocrinology, Royal Manchester Children's Hospital, UK.
FAU - Tang, V W
AU  - Tang VW
FAU - Price, D A
AU  - Price DA
FAU - Hughes, D G
AU  - Hughes DG
FAU - Wright, N B
AU  - Wright NB
FAU - Clayton, P E
AU  - Clayton PE
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PL  - Germany
TA  - J Pediatr Endocrinol Metab
JT  - Journal of pediatric endocrinology & metabolism : JPEM
JID - 9508900
RN  - 12629-01-5 (Human Growth Hormone)
SB  - IM
MH  - Adolescent
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Human Growth Hormone/*deficiency
MH  - Humans
MH  - Hypothalamo-Hypophyseal System/*pathology
MH  - Magnetic Resonance Imaging/*standards
MH  - Male
MH  - Metabolism, Inborn Errors/*diagnosis
MH  - Pituitary Gland/pathology
MH  - Predictive Value of Tests
MH  - Retrospective Studies
MH  - Sensitivity and Specificity
EDAT- 2001/01/12 11:00
MHDA- 2001/03/10 10:01
CRDT- 2001/01/12 11:00
PHST- 2001/01/12 11:00 [pubmed]
PHST- 2001/03/10 10:01 [medline]
PHST- 2001/01/12 11:00 [entrez]
AID - 10.1515/jpem.2000.13.9.1577 [doi]
PST - ppublish
SO  - J Pediatr Endocrinol Metab. 2000 Nov-Dec;13(9):1577-83. doi: 
      10.1515/jpem.2000.13.9.1577.