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Corredor B, Solís I, Zubicaray J, Sevilla J, Argente J. Small pituitary volume and central nervous system anomalies in Fanconi Anemia. Front Endocrinol (Lausanne) 2024; 15:1385650. [PMID: 39224124 PMCID: PMC11366589 DOI: 10.3389/fendo.2024.1385650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction Fanconi anemia (FA) is a genomic instability disorder associated with congenital abnormalities, including short stature and the presence of central nervous system anomalies, especially in the hypothalamic-pituitary area. Thus, differences in pituitary size could associate with the short stature observed in these patients. Our aim was to evaluate whether central nervous system abnormalities and pituitary gland volume correlate with height and hormone deficiencies in these patients. Methods In this cross-sectional exploratory study 21 patients diagnosed with FA between 2017 and 2022 in a Spanish Reference Center were investigated. Magnetic resonance imaging (MRI) was performed and pituitary volume calculated and corelated with height and other endocrine parameters. Results The percentage of abnormalities in our series was 81%, with a small pituitary (pituitary volume less than 1 SD) being the most frequent, followed by Chiari malformation type 1. The median value of pituitary volume was -1.03 SD (IQR: -1.56, -0.36). Short stature was found in 66.7% [CI95% 43-85.4]. Total volume (mm3) increases significantly with age and in pubertal stages. There were no differences between volume SD and pubertal stage, or the presence of endocrine deficiencies. No correlations were found between pituitary volume and the presence of short stature. The intraclass correlation index (ICC) average for volume was 0.85 [CI95% 0.61-0.94] indicating a good-to-excellent correlation of measurements. Discussion Central nervous system anomalies are part of the FA phenotype, the most frequent after pituitary hypoplasia being posterior fossa abnormalities, which may have clinical repercussions in the patient. It is therefore necessary to identify those who could be candidates for neurosurgical intervention. The size of the pituitary gland is smaller in these patients, but this does not seem to be related to hormone deficiency and short stature or exposure to a low dose of total body irradiation.
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Affiliation(s)
- Beatriz Corredor
- Department of Pediatrics, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Department of Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Department of Pediatrics, Hospital Universitario de Toledo, Toledo, Spain
- Department of Pediatric Endocrinology, Hospital Universitario de Toledo, Toledo, Spain
| | - Inés Solís
- Department of Pediatric Radiology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Josune Zubicaray
- Department of Pediatric Hematology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Fundación de Investigación del Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Center for Biomedical Research on Rare Diseases Network (CIBERER), Madrid, Spain
| | - Julián Sevilla
- Department of Pediatric Hematology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Fundación de Investigación del Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Center for Biomedical Research on Rare Diseases Network (CIBERER), Madrid, Spain
| | - Jesús Argente
- Department of Pediatrics, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Department of Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Department of Pediatric Endocrinology, La Princesa Research Institute, Madrid, Spain
- Department of Pediatrics, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutriciόn (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- IMDEA, Food Institute, CEIUAM+CSI, Madrid, Spain
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Kadom N, Nance M, Patterson B, Palasis S. Guidance for Pediatric Pituitary MRI Ordering: A Single Institution Improvement Initiative. AJNR Am J Neuroradiol 2024:ajnr.A8314. [PMID: 39122467 DOI: 10.3174/ajnr.a8314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/12/2024] [Indexed: 08/12/2024]
Abstract
We identified inconsistencies in the pituitary MRI ordering practices at our pediatric institution. We used an interdepartmental collaboration to develop a pituitary MRI ordering guide based on available evidence and local expertise. The initiative has led to an improvement in the appropriate use of intravenous gadolinium-based contrast agents for pediatric pituitary MRI studies.
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Affiliation(s)
- Nadja Kadom
- From the Department of Radiology (N.K., S.P.), Children's Healthcare of Atlanta, Atlanta, Georgia
- Department of Radiology and Imaging Sciences (N.K., M.N., S.P.), Emory School of Medicine, Atlanta, Georgia
| | - Michael Nance
- Department of Radiology and Imaging Sciences (N.K., M.N., S.P.), Emory School of Medicine, Atlanta, Georgia
| | - Briana Patterson
- Division of Endocrinology, Department of Pediatrics (B.P.), Emory University, Atlanta, Georgia
| | - Susan Palasis
- From the Department of Radiology (N.K., S.P.), Children's Healthcare of Atlanta, Atlanta, Georgia
- Department of Radiology and Imaging Sciences (N.K., M.N., S.P.), Emory School of Medicine, Atlanta, Georgia
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Kiremitci Yilmaz S, Yilmaz Ovali G, Ozalp Kizilay D, Tarhan S, Ersoy B. Pitfalls of diagnosing pituitary hypoplasia in the patients with short stature. Endocrine 2024:10.1007/s12020-024-03951-9. [PMID: 38969909 DOI: 10.1007/s12020-024-03951-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/27/2024] [Indexed: 07/07/2024]
Abstract
PURPOSE Height age (HA) and bone age (BA) delay is well known in the patients with short stature. Therefore assessing pituitary hypoplasia based on chronological age (CA) might cause overdiagnosis of pituitary hypoplasia. We aimed to investigate the diagnostic and prognostic value of the PH and PV based on CA, HA, or BA in the patients with GHD. METHODS Fifty-seven patients with severe and 40 patients with partial GHD and 39 patients with ISS assigned to the study. For defining the most accurate diagnosis of pituitary hypoplasia, PH and PV were evaluated based on CA, BA and HA. The relationship of each method with clinical features was examined. RESULTS The mean PV was significantly larger in patients with ISS compared to the GH-deficient patients. PV was more correlated with clinical features including height SDS, stimulated GH concentration, IGF-1 and IGFBP-3 SDS, height velocity before and after rGH therapy. We found BA-based PV could discriminate GHD from ISS (Sensitivity: 17%, specificity: 98%, positive predictive value: 94%, negative predictive value: 39%), compared to the other methods based on PH or PV respect to CA and HA. 3% of patients with ISS, 17% of patients with GHD had pituitary hypoplasia based on PV-BA. CONCLUSION PV based on BA, has the most accurate diagnostic value for defining pituitary hypoplasia. But it should be kept in mind that there might be still misdiagnosed patients by this method. PV is also a significant predictor for the rGH response.
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Affiliation(s)
- Seniha Kiremitci Yilmaz
- Division of Pediatric Endocrinology, Health Sciences University, Istanbul Haseki Training and Research Hospital, Istanbul, Turkey.
| | - Gülgün Yilmaz Ovali
- Department of Radiology, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - Deniz Ozalp Kizilay
- Division of Pediatric Endocrinology and Metabolism, Ege University, Faculty of Medicine, İzmir, Turkey
| | - Serdar Tarhan
- Department of Radiology, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - Betul Ersoy
- Division of Pediatric Endocrinology and Metabolism, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
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Oh JS, Sohn B, Choi Y, Song K, Suh J, Kwon A, Kim HS. The influence of pituitary volume on the growth response in growth hormone-treated children with growth hormone deficiency or idiopathic short stature. Ann Pediatr Endocrinol Metab 2024; 29:95-101. [PMID: 37946439 PMCID: PMC11076225 DOI: 10.6065/apem.2346052.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/30/2023] [Accepted: 05/08/2023] [Indexed: 11/12/2023] Open
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.
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Affiliation(s)
- Jun Suk Oh
- Department of Pediatrics, Konyang University Hospital, Daejeon, Korea
| | - Beomseok Sohn
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Youngha Choi
- Department of Pediatrics, Kangwon National University Hospital, Chuncheon, Korea
| | - Kyungchul Song
- Department of Pediatrics, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Junghwan Suh
- Department of Pediatrics, Endocrine Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ahreum Kwon
- Department of Pediatrics, Endocrine Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho-Seong Kim
- Department of Pediatrics, Endocrine Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
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Zakaria Z, Ismail MI, Ang SY, Idris Z. Neuroradiological Correlation of the Lateral Third Periventricular, Pituitary Gland and Stalk, Pineal Gland, Cerebral Aqueduct, and Foramen Magendie and Luschka With Intraventricular Neuroendoscopic Images: A Case Series. Cureus 2024; 16:e56952. [PMID: 38665765 PMCID: PMC11044081 DOI: 10.7759/cureus.56952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Neuroendoscopy procedures in pediatrics have expanded beyond the endoscopic third ventriculostomy. As such, a direct and angled endoscope allows further visualization around the corner, capturing the surrounding anatomy. Intraoperative live images look different than radiological images. Hence, in this single institutional experience, we correlate neuroradiology images with intraoperative intraventricular endoscopic views of the third-fourth ventricle, pituitary, pineal gland, cerebral aqueduct, and foramen magendie and luschka. Our collective case series reveals a few interesting case scenarios of normal and abnormal findings during the procedure. Careful navigation of the neuroendoscope is crucial to prevent injury to the neurovascular bundle. A close relationship with normal anatomy from radiological imaging is necessary to prevent it from getting lost once inside the ventricular cavity.
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Affiliation(s)
- Zaitun Zakaria
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia (USM), Kota Bharu, MYS
| | - Muhammad Ihfaz Ismail
- Department of Neurosciences, Hospital UniversitI Sains Malaysia (HUSM), Kota Bharu, MYS
| | - Song Yee Ang
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia (USM), Kota Bharu, MYS
| | - Zamzuri Idris
- Department of Neurosciences, School of Medical Sciences, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia (USM), Kota Bharu, MYS
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Lanzetta MA, Dalla Bona E, Tamaro G, Vidonis V, Vittori G, Faleschini E, Barbi E, Tornese G. Clinical and laboratory characteristics but not response to treatment can distinguish children with definite growth hormone deficiency from short stature unresponsive to stimulation tests. Front Endocrinol (Lausanne) 2024; 15:1288497. [PMID: 38495788 PMCID: PMC10940512 DOI: 10.3389/fendo.2024.1288497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction It has been proposed that not all children with short stature displaying an inadequate response to tests for growth hormone (GH) secretion truly suffer from GH deficiency (GHD). Only children with a monogenic cause of GHD or an identifiable combined hormonal deficiency or anatomical anomaly in the hypothalamic-pituitary axis should be considered definite GHD (dGHD). The remaining patients can be defined as a separate group of patients, "short stature unresponsive to stimulation tests" (SUS). The aim of this proof-of-concept study, was to assess whether SUS patients treated with rhGH exhibit any differences compared to GHD patients undergoing the same treatment. Methods Retrospective analysis on 153 consecutive patients with short stature and pathological response to two GH stimulation tests. Patients with dGHD were defined as those with a clear genetic or anatomical hypothalamic-pituitary anomaly, as well as those with combined pituitary hormone deficiencies and those with a known insult to the hypothalamic-pituitary axis (i.e. total brain irradiation) (n=38, 25%); those without any of the previous anomalies were defined as SUS (n=115, 75%). Results At diagnosis, dGHD and SUS populations did not differ significantly in sex (F 32% vs 28%, p=0.68), age (11.9 vs 12.1, p=0.45), height SDS at diagnosis (-2.2 vs. -2.0, p=0.35) and prevalence of short stature (height <-2 SDS) (56% vs 51%, p=0.45). IGF-1 SDS were significantly lower in dGHD (-2.0 vs -1.3, p<0.01). After 1 year of treatment, the prevalence of short stature was significantly reduced in both groups (31% in dGHD vs. 21% in SUS, p<0.01) without any significant differences between groups (p=0.19), while the increase in IGF-1 SDS for bone age was greater in the dGHD category (+1.9 vs. +1.5, p<0.01), with no further difference in IGF-1 SDS between groups. At the last available follow-up, 59 patients had reached the near adult height (NAH) and underwent retesting for GHD. No differences in NAH were found (-0.3 vs. -0.4 SDS, 0% vs. 4% of short stature). The prevalence of pathological retesting was higher in dGHD (60% vs. 10%, p<0.01) as well as of overweight and obesity (67% vs. 26%). Conclusion Stimulation tests and the equivalent benefit from rhGH therapy, cannot distinguish between dGHD and SUS populations. In addition, lower IGF-1 concentrations at baseline and their higher increase during treatment in dGHD patients, and the lack of pathological retesting upon reaching NAH in SUS patients, are facts that suggest that deficient GH secretion may not be the cause of short stature in the SUS studied population.
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Affiliation(s)
- Maria Andrea Lanzetta
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Eva Dalla Bona
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Gianluca Tamaro
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Viviana Vidonis
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Giada Vittori
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Elena Faleschini
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Egidio Barbi
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Gianluca Tornese
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
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Kılınç Uğurlu A, Özdemir Gökce A, Çakır Gündoğan S, Ekşioğlu AS, Boyraz M. MRI evaluation of cranial pathologies in rapidly progressive early puberty cases aged 8-9. Front Endocrinol (Lausanne) 2024; 14:1316333. [PMID: 38229738 PMCID: PMC10789853 DOI: 10.3389/fendo.2023.1316333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/05/2023] [Indexed: 01/18/2024] Open
Abstract
Purpose The aim of this study was to investigate the frequency and distribution of intracranial pathologies in female patients between 8 and 9 years of age who were diagnosed with early puberty (rapidly progressive) through the evaluation of MRI images. Materials and methods A total of 74 female patients diagnosed with central precocious puberty (CPP) (6-8 years) and rapidly progressive early puberty (RPEP) (8-9 years) were included in the study. The patients were categorized into two groups, normal and abnormal, based on the findings from their MRI scans. Recent literature has classified abnormal MRI findings into three groups: pathological findings, findings with a questionable relationship to CPP, and incidental findings. Furthermore, the patients were divided into four groups based on their MRI findings and whether they had CPP or RPEP : CPP (6-8 years) +Normal MRI, RPEP (8-9 years) + Normal MRI, CPP (6-8 years) +Abnormal MRI, RPEP (8-9 years) +Abnormal MRI. Results Out of the 74 girls included in the study, 54% (n=40) showed normal MRI results, while abnormal MRI findings were detected in 46% (n = 34) of the cases. No malignant lesions were identified among cases with abnormal MRI findings. The occurrence of abnormal MRI findings was observed in 46% of the PP group and 45% of the RPEP group. Incidental findings were the most common MRI findings in both groups. The proportion of cases with pathological findings and findings with a questionable relationship to CPP was similar in both groups (p = 0.06). Basal luteinizing hormone (LH) concentration was found to be higher in the RPEP (8-9 years) +Abnormal MRI group compared to the CPP (6-8 years) +Normal MRI group (p = 0.01). Conclusion Our study is the first to investigate MRI findings in cases of rapidly progressive early puberty in the age range of 8-9 years. Our study demonstrates that there is no difference in terms of intracranial findings between cases of precocious puberty at the age of 6-8 years and cases of rapidly progressive early puberty aged 8-9.
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Affiliation(s)
- Aylin Kılınç Uğurlu
- Ankara Bilkent City Hospital, Pediatric Endocrinology Clinic, Ankara, Türkiye
| | - Ayse Özdemir Gökce
- Ankara Bilkent City Hospital, Pediatric Radiology Clinic, Ankara, Türkiye
| | | | | | - Mehmet Boyraz
- Ankara Bilkent City Hospital, Pediatric Endocrinology Clinic, Ankara, Türkiye
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Picci G, Casagrande CC, Ott LR, Petro NM, Christopher‐Hayes NJ, Johnson HJ, Willett MP, Okelberry HJ, Wang Y, Stephen JM, Calhoun VD, Wilson TW. Dehydroepiandrosterone mediates associations between trauma-related symptoms and anterior pituitary volume in children and adolescents. Hum Brain Mapp 2023; 44:6388-6398. [PMID: 37853842 PMCID: PMC10681633 DOI: 10.1002/hbm.26516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 09/19/2023] [Accepted: 10/01/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION The anterior pituitary gland (PG) is a potential locus of hypothalamic-pituitary-adrenal (HPA) axis responsivity to early life stress, with documented associations between dehydroepiandrosterone (DHEA) levels and anterior PG volumes. In adults, elevated anxiety/depressive symptoms are related to diminished DHEA levels, and studies have shown a positive relationship between DHEA and anterior pituitary volumes. However, specific links between responses to stress, DHEA levels, and anterior pituitary volume have not been established in developmental samples. METHODS High-resolution T1-weighted MRI scans were collected from 137 healthy youth (9-17 years; Mage = 12.99 (SD = 1.87); 49% female; 85% White, 4% Indigenous, 1% Asian, 4% Black, 4% multiracial, 2% not reported). The anterior and posterior PGs were manually traced by trained raters. We examined the mediating effects of salivary DHEA on trauma-related symptoms (i.e., anxiety, depression, and posttraumatic) and PG volumes as well as an alternative model examining mediating effects of PG volume on DHEA and trauma-related symptoms. RESULTS DHEA mediated the association between anxiety symptoms and anterior PG volume. Specifically, higher anxiety symptoms related to lower DHEA levels, which in turn were related to smaller anterior PG. CONCLUSIONS These results shed light on the neurobiological sequelae of elevated anxiety in youth and are consistent with adult findings showing suppressed levels of DHEA in those with greater comorbid anxiety and depression. Specifically, adolescents with greater subclinical anxiety may exhibit diminished levels of DHEA during the pubertal window, which may be associated with disruptions in anterior PG growth.
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Affiliation(s)
- Giorgia Picci
- Institute for Human NeuroscienceBoys Town National Research HospitalBoys TownNebraskaUSA
- Center for Pediatric Brain HealthBoys Town National Research HospitalBoys TownNebraskaUSA
| | - Chloe C. Casagrande
- Institute for Human NeuroscienceBoys Town National Research HospitalBoys TownNebraskaUSA
| | - Lauren R. Ott
- Institute for Human NeuroscienceBoys Town National Research HospitalBoys TownNebraskaUSA
| | - Nathan M. Petro
- Institute for Human NeuroscienceBoys Town National Research HospitalBoys TownNebraskaUSA
| | | | - Hallie J. Johnson
- Institute for Human NeuroscienceBoys Town National Research HospitalBoys TownNebraskaUSA
| | - Madelyn P. Willett
- Institute for Human NeuroscienceBoys Town National Research HospitalBoys TownNebraskaUSA
| | - Hannah J. Okelberry
- Institute for Human NeuroscienceBoys Town National Research HospitalBoys TownNebraskaUSA
| | - Yu‐Ping Wang
- Department of Biomedical EngineeringTulane UniversityNew OrleansLouisianaUSA
| | | | - Vince D. Calhoun
- Tri‐Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS)Georgia State University, Georgia Institute of technology, and Emory UniversityAtlantaGeorgiaUSA
| | - Tony W. Wilson
- Institute for Human NeuroscienceBoys Town National Research HospitalBoys TownNebraskaUSA
- Center for Pediatric Brain HealthBoys Town National Research HospitalBoys TownNebraskaUSA
- Department of Pharmacology & NeuroscienceCreighton UniversityOmahaNebraskaUSA
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Maia R, Miranda A, Geraldo AF, Sampaio L, Ramaglia A, Tortora D, Severino M, Rossi A. Neuroimaging of pediatric tumors of the sellar region-A review in light of the 2021 WHO classification of tumors of the central nervous system. Front Pediatr 2023; 11:1162654. [PMID: 37416813 PMCID: PMC10320298 DOI: 10.3389/fped.2023.1162654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/07/2023] [Indexed: 07/08/2023] Open
Abstract
Sellar/suprasellar tumors comprise about 10% of all pediatric Central Nervous System (CNS) tumors and include a wide variety of entities, with different cellular origins and distinctive histological and radiological findings, demanding customized neuroimaging protocols for appropriate diagnosis and management. The 5th edition of the World Health Organization (WHO) classification of CNS tumors unprecedently incorporated both histologic and molecular alterations into a common diagnostic framework, with a great impact in tumor classification and grading. Based on the current understanding of the clinical, molecular, and morphological features of CNS neoplasms, there have been additions of new tumor types and modifications of existing ones in the latest WHO tumor classification. In the specific case of sellar/suprasellar tumors, changes include for example separation of adamantinomatous and papillary craniopharyngiomas, now classified as distinct tumor types. Nevertheless, although the current molecular landscape is the fundamental driving force to the new WHO CNS tumor classification, the imaging profile of sellar/suprasellar tumors remains largely unexplored, particularly in the pediatric population. In this review, we aim to provide an essential pathological update to better understand the way sellar/suprasellar tumors are currently classified, with a focus on the pediatric population. Furthermore, we intend to present the neuroimaging features that may assist in the differential diagnosis, surgical planning, adjuvant/neoadjuvant therapy, and follow-up of this group of tumors in children.
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Affiliation(s)
- Rúben Maia
- Department of Neuroradiology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - André Miranda
- Diagnostic Neuroradiology Unit, Imaging Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Ana Filipa Geraldo
- Diagnostic Neuroradiology Unit, Imaging Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Luísa Sampaio
- Department of Neuroradiology, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Antonia Ramaglia
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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10
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Issrani R, Alanazi SH, Alrashed FF, Alrasheed SS, Bader AK, Prabhu N, Alam MK, Khan ZA, Khan TU. Radiographic Analysis of Morphological Variations of Sella Turcica in Different Skeletal Patterns Among Saudi Subpopulations. Int J Gen Med 2023; 16:2481-2491. [PMID: 37342405 PMCID: PMC10278862 DOI: 10.2147/ijgm.s413903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/16/2023] [Indexed: 06/22/2023] Open
Abstract
Background Size and shape of the sella turcica is considered vital for many radiographic analyses. Objectives To assess and compare the linear dimensions and shape of sella turcica on digital lateral cephalograms in Saudi subpopulation with different skeletal patterns, age groups and genders. Methodology A total of 300 digital lateral cephalograms were retrieved from the hospital archive. The selected cephalograms were grouped based on the age, gender, and skeletal types. The linear dimensions and shape of sella turcica were measured on each radiograph. Data were analyzed using an independent t-test and a one-way ANOVA. To test the inter-relationship of age, gender, and skeletal type with the dimensions of sella turcica, regression analyses were used. Statistical significance was set at P ≤ 0.01. Results Significant differences in linear dimensions between the age groups (P < 0.001) and genders (P < 0.001) were noted. On comparing sella size with different skeletal types, a significant difference was found for all sella dimensions (P < 0.001). The mean length, depth and diameter among skeletal class III were significantly higher than that among classes I and II. On comparing age, gender, and skeletal type with size of sella, age and skeletal type were significantly related to the change of length, depth and diameter (P < 0.001), whereas gender was found to be significantly related only to a change in length of the sella (P < 0.01). For the sella shape, normal morphology was noted in 44.3% of patients. Conclusion According to the findings of this study, the measurements of sella can be used as reference standards for future studies in Saudi subpopulation.
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Affiliation(s)
- Rakhi Issrani
- Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka, Kingdom of Saudi Arabia
| | | | | | | | - Alzarea K Bader
- Department of Prosthetic Dental Sciences, College of Dentistry, Jouf University, Sakaka, Kingdom of Saudi Arabia
| | - Namdeo Prabhu
- Department of Oral & Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jouf University, Sakaka, Kingdom of Saudi Arabia
| | - Mohammad Khursheed Alam
- Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka, Kingdom of Saudi Arabia
- Center of Transdisciplinary Research (CFTR), Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
- Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, Bangladesh
| | - Zafar Ali Khan
- Department of Oral & Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jouf University, Sakaka, Kingdom of Saudi Arabia
| | - Tahir Ullah Khan
- Department of Oral & Maxillofacial Surgery, Lady Reading Hospital Medical Teaching Institute, Peshawar, Pakistan
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11
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Zhang H, Zhang S, Shang M, Wang J, Wei L, Wang S. Pituitary stalk changes on magnetic resonance imaging following pituitary adenoma resection using a transsphenoidal approach. Front Neurol 2023; 14:1049577. [PMID: 36779061 PMCID: PMC9911825 DOI: 10.3389/fneur.2023.1049577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/04/2023] [Indexed: 01/28/2023] Open
Abstract
Objective We aimed to investigate the magnetic resonance imaging (MRI) findings and clinical significance of position and changes in morphology of the pituitary stalk following pituitary adenoma (PA) resection using a transsphenoidal approach. Methods We collected clinical and MRI data of 108 patients with PA after transsphenoidal surgery. Diameter, length, and coronal deviation of the pituitary stalk were measured pre-, post-, and mid-term post-operatively, to observe pituitary stalk morphology. Results Of 108 patients, 53 pituitary stalks were recognisable pre-operatively. The angle between the pituitary stalk and the median line was 7.22°-50.20° (average, 25.85°) in 22 patients with left-sided pituitary stalks and 5.32°-64.05° (average, 21.63°) in 20 patients with right-sided pituitary stalks. Of 42 patients with preoperative pituitary stalk deviation, 41 had an early postoperative recovery and 1 had increased deviation. In the mid-term postoperative period, 21 of 42 patients had pituitary stalks located centrally. In 53 patients, the pituitary stalk length was 1.41-11.74 mm (mean, 6.12 mm) pre-operatively, 3.61-11.63 mm (mean, 6.93 mm) in the early postoperative period, and 5.37-17.57 mm (mean, 8.83 mm) in the mid-term postoperative period. In the early postoperative period, 58 (53.70%) patients had posterior pituitary bright spots (PPBS) and 28 (25.92%) had diabetes insipidus (DI). Conclusion Pre-operatively, the pituitary stalk was compressed and thinned. Post-operatively, it could be stretched to a "normal state", and its position showed a gradual centring trend. Post-operatively, the length of the pituitary stalk gradually increased. The PPBS in the early postoperative period negatively correlated with postoperative DI.
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Affiliation(s)
- Huijian Zhang
- Department of Neurosurgery, 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China
| | - Shuai Zhang
- Department of Neurosurgery, Huanggang Central Hospital, Huanggang, Hubei, China
| | - Mingchao Shang
- Department of Neurosurgery, 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China
| | - Jiaxing Wang
- Department of Neurosurgery, 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China
| | - Liangfeng Wei
- Department of Neurosurgery, 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China
| | - Shousen Wang
- Department of Neurosurgery, 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China,Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China,*Correspondence: Shousen Wang ✉
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12
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Almaghraby A, Jaju A, Ryan ME, Rychlik K, Habiby RL, Brickman WJ. Is Gadolinium Contrast Necessary for Pituitary MRI in the Evaluation of Pediatric Short Stature and Growth Hormone Deficiency? Horm Res Paediatr 2022; 94:201-210. [PMID: 34425574 DOI: 10.1159/000519031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 08/08/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Short stature is a common concern that necessitates pediatric endocrinology evaluation. Growth hormone deficiency (GHD) is a commonly considered etiology. Brain and pituitary magnetic resonance imaging (MRI) with gadolinium-based contrast agents (GBCAs) is the most widely used imaging in assessing patients with GHD. Given the significant strides made in MRI technology, the need for contrast material should be reassessed. METHOD We performed a retrospective review of healthy patients with short stature and/or GHD who underwent brain and pituitary MRI with and without contrast to assess the added value of contrast administration. RESULTS 227/318 identified patients underwent growth hormone (GH) stimulation testing; 28 (12.3%) with normal GH response and 62 (27.3%) with severe GHD. We found a low incidence of sellar and suprasellar pathologies. When comparing noncontrast and contrast MRI, we found perfect agreement in detecting abnormal posterior pituitary bright spots (kappa:1.0) and substantial agreement in detecting pars intermedia cysts and posterior superior sellar cysts (kappa: 0.74 and 0.71, respectively). Initially, only moderate agreement was found in detecting infundibular abnormalities (kappa: 0.51), although a revised noncontrast MRI protocol with high-resolution 3D images enabled visualization of the infundibulum. CONCLUSION The MRI evaluation of healthy patients with short stature and/or isolated GHD may be completed without the use of GBCAs. The slight overestimation of pituitary stalk interruption by noncontrast images can be overcome by adding newer high-resolution sequences.
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Affiliation(s)
- Abdullah Almaghraby
- Division of Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alok Jaju
- Division of Neuroradiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Maura E Ryan
- Division of Neuroradiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Karen Rychlik
- Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.,Stanley Manne Children's Research Institute, Biostatistics Research Core, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Reema L Habiby
- Division of Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Wendy J Brickman
- Division of Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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13
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Hage C, Gan HW, Ibba A, Patti G, Dattani M, Loche S, Maghnie M, Salvatori R. Advances in differential diagnosis and management of growth hormone deficiency in children. Nat Rev Endocrinol 2021; 17:608-624. [PMID: 34417587 DOI: 10.1038/s41574-021-00539-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 02/07/2023]
Abstract
Growth hormone (GH) deficiency (GHD) in children is defined as impaired production of GH by the pituitary gland that results in growth failure. This disease might be congenital or acquired, and occurs in isolation or in the setting of multiple pituitary hormone deficiency. Isolated GHD has an estimated prevalence of 1 patient per 4000-10,000 live births and can be due to multiple causes, some of which are yet to be determined. Establishing the correct diagnosis remains key in children with short stature, as initiating treatment with recombinant human GH can help them attain their genetically determined adult height. During the past two decades, our understanding of the benefits of continuing GH therapy throughout the transition period from childhood to adulthood has increased. Improvements in transitional care will help alleviate the consequent physical and psychological problems that can arise from adult GHD, although the consequences of a lack of hormone replacement are less severe in adults than in children. In this Review, we discuss the differential diagnosis in children with GHD, including details of clinical presentation, neuroimaging and genetic testing. Furthermore, we highlight advances and issues in the management of GHD, including details of transitional care.
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Affiliation(s)
- Camille Hage
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hoong-Wei Gan
- Genetics & Genomic Medicine Research and Teaching Department, University College London Great Ormond Street Hospital Institute of Child Health, London, UK
- Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Anastasia Ibba
- Paediatric Endocrine Unit, Paediatric Hospital Microcitemico "A. Cao", AO Brotzu, Cagliari, Italy
| | - Giuseppa Patti
- Department of Paediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genova, Italy
| | - Mehul Dattani
- Genetics & Genomic Medicine Research and Teaching Department, University College London Great Ormond Street Hospital Institute of Child Health, London, UK
- Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sandro Loche
- Paediatric Endocrine Unit, Paediatric Hospital Microcitemico "A. Cao", AO Brotzu, Cagliari, Italy
| | - Mohamad Maghnie
- Department of Paediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genova, Italy
| | - Roberto Salvatori
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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14
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Kimura T, Umino S, Kitamura M, Yatsuga S. Increased Serum-Immunoglobulin G4 Levels in a 12-Year-Old Male Patient With Central Diabetes Insipidus. Cureus 2021; 13:e17362. [PMID: 34567902 PMCID: PMC8454289 DOI: 10.7759/cureus.17362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 11/24/2022] Open
Abstract
Immunoglobulin G4 (IgG4)-related disorders are characterized by tissue hypertrophy due to IgG4-positive cell infiltration and increased serum IgG4 levels. IgG4-related hypophysitis (IgG4-RH) is characterized by pituitary hypertrophy, IgG4-positive cell infiltration, central diabetes insipidus, and increased serum IgG4 levels. IgG4-RH is diagnosed through diagnostic criteria. A few cases of IgG4-RH in children have been reported. We report a case of CDI with increased serum IgG4 levels that failed to meet the diagnostic criteria of IgG4-RH. The patient developed polyuria and polydipsia at age 11 and was diagnosed as having idiopathic CDI at age 12. The patient was not treated with steroids and is well controlled with antidiuretic hormones. It has been reported that pediatric IgG4-RH differs from that of adults in several respects. We believe that the pediatric IgG4-RH may not fit the diagnostic criteria of adults. There may be also other cases of increased serum IgG4 levels in pediatric patients with idiopathic CDI. We do not know if they are subtypes of IgG4-RH or if serum IgG4 levels are by chance raised in CDI, however, we report them here because IgG4-RH in children may be different from that in adults.
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Affiliation(s)
- Takuro Kimura
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, JPN.,Department of Neonatology, St. Mary's Hospital, Kurume, JPN
| | - Satoko Umino
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, JPN
| | - Miyuki Kitamura
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, JPN
| | - Shuichi Yatsuga
- Department of Pediatrics, Aso Iizuka Hospital, Iizuka City, JPN.,Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, JPN
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15
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The bridging and normal dimensions of sella turcica in Yemeni individuals. Oral Radiol 2021; 38:162-170. [PMID: 34143355 PMCID: PMC8211719 DOI: 10.1007/s11282-021-00541-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 06/03/2021] [Indexed: 11/21/2022]
Abstract
Objective This study aimed to evaluate and compare sizes, shapes and bridging of the sella turcica (ST) in Yemeni individuals with different skeletal patterns, genders, and ages, and to assess the association between the linear dimension of ST and gender, age, or skeletal patterns. The standard anatomical structure of ST among Yemeni subjects is still unknown and this study can be considered as the first reference regarding ST of Yemeni individuals.
Materials and methods Cephalogram images for 234 subjects (167 females and 67 males) were traced and classified for groups by gender, age, and dentofacial skeletal patterns. Size, shape, and bridging of ST were assessed. Multivariate ANOVA (MANOVA) analysis was used to detect the interaction between gender, age, and skeletal patterns on ST dimensions.
Results The mean values for length, anteroposterior diameter, and depth of ST were 8.02 ± 1.67, 11.37 ± 1.60, and 8.56 ± 1.26 mm, respectively. A significant difference in length of ST between gender and age stages (p < 0.05) was detected while older subjects revealed a greater anteroposterior diameter than younger subjects (p < 0.05). The morphological variations of ST were observed in 55.6% of samples. No significant association between the shape of ST and skeletal patterns (p > 0.05) was found.
Conclusions ST bridging was highly prevalent in Yemeni subjects (35.9%). Samples showed a higher rate of complete ST bridging in the three skeletal patterns, Class I (17.1%), Class II (18.9%), and Class III (20%). ST dimensions and shape findings in this study can be used as reference standards for further investigation, including the ST area in the Yemeni population.
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16
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Baldo F, Marin M, Murru FM, Barbi E, Tornese G. Dealing With Brain MRI Findings in Pediatric Patients With Endocrinological Conditions: Less Is More? Front Endocrinol (Lausanne) 2021; 12:780763. [PMID: 35095759 PMCID: PMC8791386 DOI: 10.3389/fendo.2021.780763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/20/2021] [Indexed: 12/22/2022] Open
Abstract
Neuroimaging is a key tool in the diagnostic process of various clinical conditions, especially in pediatric endocrinology. Thanks to continuous and remarkable technological developments, magnetic resonance imaging can precisely characterize numerous structural brain anomalies, including the pituitary gland and hypothalamus. Sometimes the use of radiological exams might become excessive and even disproportionate to the patients' medical needs, especially regarding the incidental findings, the so-called "incidentalomas". This unclarity is due to the absence of well-defined pediatric guidelines for managing and following these radiological findings. We review and summarize some indications on how to, and even if to, monitor these anomalies over time to avoid unnecessary, expensive, and time-consuming investigations and to encourage a more appropriate follow-up of brain MRI anomalies in the pediatric population with endocrinological conditions.
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Affiliation(s)
| | - Maura Marin
- University of Trieste, Trieste, Italy
- *Correspondence: Maura Marin,
| | - Flora Maria Murru
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Egidio Barbi
- University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
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17
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Demiral M, Salih Karaca M, Unal E, Baysal B, Taner Baran R, Demirbilek H, Nuri Ozbek M. A novel diagnostic tool for the evaluation of hypothalamic-pituitary region and diagnosis of growth hormone deficiency: pons ratio. J Pediatr Endocrinol Metab 2020; 33:735-742. [PMID: 32436858 DOI: 10.1515/jpem-2019-0321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 03/21/2020] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Meliha Demiral
- Gazi Yasargil Training and Research Hospital Clinics of Paediatric Endocrinology, Diyarbakır, Turkey
| | - Mehmet Salih Karaca
- Gazi Yasargil Training and Research Hospital Clinics of Radiology, Diyarbakir, Turkey
| | - Edip Unal
- Gazi Yasargil Training and Research Hospital Clinics of Paediatric Endocrinology, Diyarbakır, Turkey
| | - Birsen Baysal
- Gazi Yasargil Training and Research Hospital Clinics of Paediatrics, Diyarbakır, Turkey
| | - Rıza Taner Baran
- Antalya Training and Research Hospital Clinics of Paediatric Endocrinology, Antalya, Turkey
| | - Huseyin Demirbilek
- Hacettepe University, Faculty of Medicine, Department of Paediatric Endocrinology, Ankara, Turkey
| | - Mehmet Nuri Ozbek
- Gazi Yasargil Training and Research Hospital Clinics of Paediatric Endocrinology, Diyarbakır, Turkey
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18
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Anastassiadis C, Jones SL, Pruessner JC. Imaging the pituitary in psychopathologies: a review of in vivo magnetic resonance imaging studies. Brain Struct Funct 2019; 224:2587-2601. [DOI: 10.1007/s00429-019-01942-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 08/13/2019] [Indexed: 12/17/2022]
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19
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Abstract
Hypopituitarism is defined as a decreased release of hypophyseal hormones, which may be caused by disease of the pituitary gland disease or hypothalamus. The clinical findings of neonatal hypopituitarism depend on the causes and on presence and extent of hormonal deficiency. Patients may be asymptomatic or may demonstrate non-specific symptoms, but may still be at risk for development of pituitary hormone deficiency over time. Patient history, physical examination, endocrinological, radiological and genetic evaluations are all important for early diagnosis and treatment. The aim of this paper was to present a review of etiological factors, clinical findings, diagnosis and treatment approaches in neonatal hypopituitarism.
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Affiliation(s)
- Selim Kurtoğlu
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Neonatalogy, Kayseri, Turkey,Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Kayseri, Turkey
| | - Ahmet Özdemir
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Neonatalogy, Kayseri, Turkey,* Address for Correspondence: Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Neonatalogy, Kayseri, Turkey Phone: +90 352 207 66 66 E-mail:
| | - Nihal Hatipoğlu
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Kayseri, Turkey
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20
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Pasquini L, Tortora D, Manunza F, Rossi Espagnet MC, Figà-Talamanca L, Morana G, Occella C, Rossi A, Severino M. Asymmetric cavernous sinus enlargement: a novel finding in Sturge-Weber syndrome. Neuroradiology 2019; 61:595-602. [PMID: 30747269 DOI: 10.1007/s00234-019-02182-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/29/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Enlargement of deep cerebral veins and choroid plexus engorgement are frequently reported in Sturge-Weber syndrome. We aim to describe cavernous sinus involvement in patients with this syndrome and to identify possible clinical-neuroimaging correlations. METHODS Sixty patients with Sturge-Weber syndrome (31 females, mean age 4.5 years) and 120 age/sex-matched controls were included in this retrospective study. We performed a visual analysis to identify patients with asymmetric cavernous sinus enlargement. Then, we measured on axial T2WI the left (A), right (B), and bilateral (LL) transverse diameters of the cavernous sinus. We calculated the module of the difference |A-B| and the cavernous sinus asymmetry index as the ratio |A-B|/LL. Differences among groups were assessed by Mann-Whitney U and Kruskal-Wallis tests. Clinicoradiological associations were evaluated by Fisher exact test. RESULTS We found seven subjects (11.6%) with asymmetric CS enlargement. The |A-B| and cavernous sinus asymmetry index were higher in patients with asymmetric CS enlargement compared with controls and patients without visible CS abnormalities (pB < 0.05). Asymmetric CS enlargement was always ipsilateral to facial port-wine stains (7/7), and, when present, to leptomeningeal vascular malformations (4/7). It was significantly associated with ipsilateral bone marrow changes (p = 0.013) and dilated veins (p = 0.002). Together with brain atrophy and deep venous dilatation, this sign was associated with neurological deficits (p < 0.05). CONCLUSIONS We expanded the spectrum of venous abnormalities in SWS, showing the presence of asymmetric cavernous sinus enlargement in more than one tenth of patients, likely related to increased venous drainage.
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Affiliation(s)
- Luca Pasquini
- Neuroradiology Unit, NESMOS Department, Sant'Andrea Hospital, La Sapienza University, Rome, Italy
| | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | | | | | | | - Giovanni Morana
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Corrado Occella
- Dermatology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy.
| | - Mariasavina Severino
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy
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Kara Ö, Esen I, Tepe D, Gülleroğlu NB, Tayfun M. Relevance of Pituitary Gland Magnetic Resonance Imaging Results with Clinical and Laboratory Findings in Growth Hormone Deficiency. Med Sci Monit 2018; 24:9473-9478. [PMID: 30594946 PMCID: PMC6322714 DOI: 10.12659/msm.911977] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The present study investigated the relationship between detection of organic pathologies with magnetic resonance imaging of the pituitary gland, clinical and laboratory findings, and treatment response. MATERIAL AND METHODS The study included a total of 183 patients who had isolated growth hormone deficiency, received at least 1 year of treatment, returned regularly for follow-ups, and whose pituitary magnetic resonance images were available. The patients were divided into 2 groups: those with and without pathological evidence with magnetic resonance imaging. Clinical and laboratory features and treatment responses were compared between patients with and without pathological evidence with magnetic resonance imaging. RESULTS Of the 183 patients, 105 were females and 78 were males, and 114 patients (62.2%) were prepubertal and 69 patients (37.8%) were pubertal. Their mean age was 10.01±3.25 years (1-17.6 years). Pituitary images of 153 (83.6%) patients were normal. Of the patients with detected pathologies (16.4%), 19 (10,4%) had pituitary hypoplasia, 5 (2.7%) had partial empty sella, 3 (1.7%) had ectopic neurohypophysis and 3 (1.7%) had empty sella, pineal, and arachnoid cyst. A statistically significant increase was observed in the height increase rate after treatment compared to before treatment in both groups (p<0.001). However, the group with pathology had a statistically significant (p=0. 007) post-treatment increase height rate. Although in the group with pathology there was a lower L-DOPA and clonidine peak GH response, there was not any statistically significant difference between the 2 groups (p=0.051, p=0.113). Pituitary gland length was also shorter in the group with pathology compared to the group without pathology (P<0.001). CONCLUSIONS Magnetic resonance imaging is a useful tool in assessing GH deficiency pathogenesis and in predicting treatment response.
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Affiliation(s)
- Özlem Kara
- Department of Pediatric Endocrinology, Ankara Child Disease Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Ihsan Esen
- Department of Pediatric Endocrinology, Ankara Child Disease Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Derya Tepe
- Department of Pediatric Endocrinology, Ankara Child Disease Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Nadide B Gülleroğlu
- Department of Radiology, Ankara Child Disease Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Meltem Tayfun
- Department of Pediatric Endocrinology, Ankara Child Disease Hematology Oncology Training and Research Hospital, Ankara, Turkey
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22
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Törel Ergür A, Odabaşı Güneş S, Tan S, Tandırcıoğlu ÜA. Intracranial Lesions in Children and Adolescents with Morbid Obesity. Balkan Med J 2018; 34:108-112. [PMID: 28418336 PMCID: PMC5394290 DOI: 10.4274/balkanmedj.2015.1541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Intracranial lesions may affect the hypothalamo-hypophyseal axis and lead to some neuro-endocrinological dysfunctions (hyperphagia, sleep disorders and hormonal dysfunctions). There is a very limited number of studies about childhood obesity and intracranial lesions. Aims: To evaluate the incidence of intracranial lesions and its role in clinical symptoms and aetiology in cases with morbid obesity who have been admitted to the paediatric endocrinology department with this complaint. Study Design: Cross-sectional study. Methods: A total of 120 cases admitted to the paediatric endocrinology department with the complaint of morbid obesity between 2002 and 2015 were included in this study. A detailed history was taken and a physical examination was performed; biochemical, hormonal parameters were evaluated. Contrast dynamic magnetic resonance imaging was performed in order to visualize cranial pathologies. Results: An intracranial lesions was detected in 16.6% of the patients and 55% of these lesions were adenoma of the hypophysis. Prolactin levels were increased in six patients but front hypophyseal hormone levels were within normal range in the rest of the patients. Growth velocity of the patients was not affected. Conclusion: In our study, the incidence of intracranial lesions in children and adolescents with morbid obesity was much higher than in the normal population. According to this data, we are of the opinion that contrast dynamic magnetic resonance imaging is helpful in children with morbid obesity for the early detection of the mass before it causes any clinical or neurological symptoms and in the prevention of future complications.
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Affiliation(s)
- Ayça Törel Ergür
- Department of Pediatrics, Division of Pediatric Endocrinology, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey
| | - Sevinç Odabaşı Güneş
- Department of Pediatrics, Division of Pediatric Endocrinology, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey
| | - Sinan Tan
- Department of Radiology, Kırıkkkale University Faculty of Medicine, Kırıkkale, Turkey
| | - Ü Ayşe Tandırcıoğlu
- Department of Pediatrics, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey
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Koizumi M, Ida S, Shoji Y, Etani Y, Hatsukawa Y, Okamoto N. Endocrine status of patients with septo-optic dysplasia: fourteen Japanese cases. Clin Pediatr Endocrinol 2017; 26:89-98. [PMID: 28458461 PMCID: PMC5402310 DOI: 10.1297/cpe.26.89] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 02/20/2017] [Indexed: 11/17/2022] Open
Abstract
A clinical diagnosis of septo-optic dysplasia (SOD) is made when two or more of the
classical triad of optic nerve hypoplasia, pituitary hormone abnormalities or midline
brain defects. To date, a clinical study of SOD, regarding its endocrinological features
in particular, has not been undertaken in Japan. We retrospectively evaluated 14 SOD
patients at our institution. Hormonal dysfunction was present in 78% of cases: ten cases
presented combined hypopituitarism and one case presented precocious puberty. GHD and
hypothyroidism were the most common endocrinopathies. A thin pituitary stalk and a gradual
decrease in hormone secretion were the main characteristics. SOD patients usually visited
ophthalmologists during early infancy because of eye problems; however, the medical
examination did not always lead to endocrine assessments being made. Consequently,
children who have eye problems with optic nerve hypoplasia should undergo head MRI
imaging. If diagnosed with SOD, it is very important to evaluate pituitary functions.
Their endocrinological status should be followed for a long time, even if they do not
exhibit any endocrinological problems at evaluation.
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Affiliation(s)
- Mikiko Koizumi
- Department of Gastroenterology and Endocrinology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Shinobu Ida
- Department of Gastroenterology and Endocrinology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Yasuko Shoji
- Department of Gastroenterology and Endocrinology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Yuri Etani
- Department of Gastroenterology and Endocrinology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Yoshikazu Hatsukawa
- Department of Ophthalmology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Nobuhiko Okamoto
- Department of Medical Genetics, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
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