The evolution of pituitary cysts in growth hormone-treated children

OBJECTIVES

We have previously shown that pituitary cysts may affect growth hormone secretion. This study sought to determine cyst evolution during growth hormone treatment in children.

METHODS

Forty-nine patients with short stature, a pituitary cyst, and at least two brain MRI scans were included. The percent of the pituitary gland occupied by the cyst (POGO) was calculated, and a cyst with a POGO of ≤15% was considered small, while a POGO >15% was considered large.

RESULTS

Thirty-five cysts were small, and 14 were large. Five of the 35 small cysts grew into large cysts, while 6 of the 14 large cysts shrunk into small cysts. Of 4 cysts that fluctuated between large and small, 3 presented as large and 1 as small. Small cysts experienced greater change in cyst volume (CV) (mean=61.5%) than large cysts (mean=-0.4%). However, large cysts had a greater net change in CV (mean=44.2 mm³) than small cysts (mean=21.0 mm³). Older patients had significantly larger mean pituitary volume than younger patients (435.4 mm³ vs. 317.9 mm³) and significantly larger mean CV than younger patients (77.4 mm³ vs. 45.2 mm³), but there was no significant difference in POGO between groups.

CONCLUSIONS

Pituitary cyst size can vary greatly over time. Determination of POGO over time is a useful marker for determining the possibility of a pathologic effect on pituitary function since it factors both cyst and gland volume. Large cysts should be monitored closely, given their extreme, erratic behavior.

Epilepsy and the law: an Indian perspective

All over the world epileptic patients have traditionally been discriminated legally in matters affecting their everyday existence. India is no exception. In the current paper certain important issues are explored, namely, epilepsy in relation to marriage, criminality, driving and socio-economic crimes.