Ann Pediatr Endocrinol Metab.  2024 Apr;29(2):95-101. 10.6065/apem.2346052.026.

The influence of pituitary volume on the growth response in growth hormone-treated children with growth hormone deficiency or idiopathic short stature

• Oh JS
• Sohn B
• Choi Y
• Song K
• Suh J
• Kwon A
• Kim HS

• KMID: 2554680
• DOI: http://doi.org/10.6065/apem.2346052.026

Abstract

Purpose
Magnetic resonance imaging (MRI) can be used for assessing the morphology of the pituitary gland in children with short stature. The purposes of this study were: (1) to determine if pituitary volume (PV) can distinguish patients with growth hormone (GH) deficiency from those with idiopathic short stature (ISS), (2) to validate an association between PV and severity of GH deficiency, and (3) to compare PV between good and poor response groups in children with GH deficiency or ISS after 1 year of treatment.
Methods
Data were collected from the medical records of 152 children with GH deficiency or ISS who underwent GH stimulation test, sella MRI, and GH treatment for at least 1 year. Estimated PVs were calculated using the formula of an ellipsoid. We compared the PVs in patients with GH deficiency with those of patients with ISS. In addition, we assessed the association between PV and severity of GH deficiency, and we assessed growth response after treatment.
Results
No difference was observed in PV between patients with GH deficiency and those with ISS. The severity of the GH deficiency seemed to be associated with PV (P=0.082), and the height of the pituitary gland was associated with severity of GH deficiency (P<0.005). The PV in the good response group was less than that of the poor response group in patients with GH deficiency (P<0.005), and PV showed no association with responsiveness to GH treatment in patients with ISS (P=0.073).
Conclusion
The measurement of PV cannot be used for differential diagnosis between GH deficiency and ISS. In patients with GH deficiency, PV tended to be smaller as the severity of GH deficiency increased, but the difference was not significant. PV may be a good response predictor for GH treatment. Further studies, including a radiomics-based approach, will be helpful in elucidating the clinical implications of pituitary morphology in patients with short stature.

Keyword

Dwarfism; Idiopathic short stature; Growth hormone deficiency; Growth response; Pituitary gland

Figure

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  Fig. 1. Flowchart showing the study selection process. SDS, standard deviation score; GH, growth hormone; MRI, magnetic resonance imaging. Growth hormone deficiency was diagnosed based on decreased growth hormone secretion (below 10 ng/mL) in 2 stimulation tests.

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  Fig. 2. (A) Anteroposterior diameter of the pituitary gland on midsagittal plane (a). (B) Height (b) and horizontal diameter of the pituitary gland on coronal plane (c).

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  Fig. 3. Association between pituitary size and severity of GH deficiency. GH deficiency was diagnosed based on decreased growth hormone secretion (below 10 ng/ mL) in 2 stimulation tests. Data from ISS subjects were comparable to those of the group with peak GH higher than 10 ng/mL. SDS, standard deviation score; GH, growth hormone: ISS, idiopathic short stature. Analysis of variance was used in analysis to compare means.

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  Fig. 4. Correlation between height gain in SDS during the first year of growth hormone treatment and PV in growth hormone deficiency (A) and idiopathic short stature (B). SDS, standard deviation score; PV, pituitary volume. Pearson correlation analysis was used to analyze correlation coefficients.

Reference

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