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

Deal, Cheri
Hasselmann, Caroline
Pfäffle, Roland W.
Zimmermann, Alan G.
Quigley, Charmian A.
Child, Christopher J.
Shavrikova, Elena P.
Cutler, Gordon B. Jr.
Blum, Werner F.

^aUniversity of Montreal, Hôpital Sainte Justine, Montreal, Que., Canada; ^bHospital for Children and Adolescents, University of Leipzig, Leipzig, and ^cLilly Research Laboratories, Eli Lilly and Company, Bad Homburg, Germany; ^dLilly Research Laboratories, Eli Lilly and Company, Indianapolis, Ind., and ^eGordon Cutler Consultancy, Deltaville, Va., USA; ^fLilly Research Laboratories, Eli Lilly and Company, Windlesham, UK; ^gPSI Company Ltd, St Petersburg, Russia

^*Prof. Cheri Deal, Pediatric Endocrinology and Diabetes, University of Montreal/CHU Ste-Justine Hospital, 3175 Cote Ste-Catherine, Montreal, Quebec H3T 1C5 (Canada), E-Mail [email protected]

Received February 14, 2013; Accepted March 12, 2013; previously published online May 15, 2013

Hormone Research in Paediatrics 79(5):p 283-292, June 2013. | DOI: 10.1159/000350829

Abstract

Background/Aims:

Magnetic resonance imaging (MRI) is used to investigate the etiology of growth hormone deficiency (GHD). This study examined relationships between MRI findings and clinical/hormonal phenotypes in children with GHD in the observational Genetics and Neuroendocrinology of Short Stature International Study, GeNeSIS.

Methods:

Clinical presentation, hormonal status and first-year GH response were compared between patients with pituitary imaging abnormalities (n = 1, 071), patients with mutations in genes involved in pituitary development/GH secretion (n = 120) and patients with idiopathic GHD (n = 7, 039).

Results:

Patients with hypothalamic-pituitary abnormalities had more severe phenotypes than patients with idiopathic GHD. Additional hormonal deficiencies were found in 35% of patients with structural abnormalities (thyroid-stimulating hormone > adrenocorticotropic hormone > luteinizing hormone/follicle-stimulating hormone > antidiuretic hormone), most frequently in patients with septo-optic dysplasia (SOD). Patients with the triad [ectopic posterior pituitary (EPP), pituitary aplasia/hypoplasia and stalk defects] had a more severe phenotype and better response to GH treatment than patients with isolated abnormalities. The sex ratio was approximately equal for patients with SOD, but there was a significantly higher proportion of males (approximately 70%) in the EPP, pituitary hypoplasia, stalk defects, and triad categories.

Conclusion:

This large, international database demonstrates the value of classification of GH-deficient patients by the presence and type of hypothalamic-pituitary imaging abnormalities. This information may assist family counseling and patient management.