Abstract
The purpose of the present study was to assess the presence and the time-course of contrast-enhancement in the pituitary gland and pituitary stalk of 24 patients with isolated growth hormone (GH) deficiency and multiple pituitary hormone deficiency. The patients were evaluated clinically (auxological measurements), endocrinologically (spontaneous GH secretion and GH stimulation tests) and with conventional MRI scans. In addition, fast-framing dynamic magnetic resonance imaging (MRI) with Gd-DTPA enhancement was used to quantitate the time course of contrast enhancement within the neurohypophysis, pituitary stalk, postero-superior adenohypophysis and antero-inferior adenohypophysis. In 3 patients without evidence of abnormalities at normal conventional MRI scans (normal anterior lobe and pituitary stalk, normal posterior lobe) and a high response to the GRF provocation test, sequential time-resolved Gd-enhanced MRI demonstrates reduced contrast enhancement in the pituitary stalk. These findings are consistent with impairment in stalk vasculature, presumably located at the level of the portal venous system, and could play a role in the pathogenesis of pituitary hormonal deficiency.
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De Luca F., Bernasconi S., Blandino A., Cavallo L., Cisternino M. Auxological, clinical and neuroradiological findings in infants with early onset growth hormone deficiency. Acta Paediatr. 1995, 84: 561–565.
Maghnie M., Triulzi F., Larizza D., Scotti G., Beluffi G., Cecchini A., Severi F. Hypothalamic pituitary dwarfism: comparison between MR Imaging and CT findings. Pediatr. Radiol. 1990, 120: 229–235.
Scotti G., Triulzi F., Chiumello G., Di Natale B. New imaging techniques in endocrinology: Magnetic resonance of the pituitary gland and sella turcica. Acta Paediatr. Scand. 1989, 56: 5–14.
Avataneo T., Cirillo S., Cesarini F., Bessè F., Vannelli S., Benso L., Bona G. La risonanza magnetica nello studio dei pazienti con bassa statura di origine ipotalamo-ipofisaria. Radiol. Med. 1994, 88: 68–73.
Bressani N., Di Natale B., Pellini C., Triulzi F., Scotti G., Chiumello G. Evidence of morphological and functional abnormalities in the hypothalamus of growth hormone deficient children: a combined Magnetic Resonance Imaging and endocrine study. Horm. Res. 1990, 4: 189–192.
Brown R.S., Bhatia V., Hayes E. An apparent cluster of congenital hypopituitarism in Central Massachusetts: Magnetic Resonance Imaging and hormonal studies. J. Clin. Endocrinol. Metab. 1991, 72: 12–18.
Marvaha R., Menon P.S.N., Jena A., Pant C., Sethi A.K., Sapra M.L. Hypothalamo-pituitary axis by magnetic resonance imaging in isolated growth hormone deficiency. Patients born by normal delivery. J. Clin. Endocrinol. Metab. 1992, 74: 654–659.
Tatsumi K., Miyai K., Notomi T., Kaibe K., Amino N., Mizuno Y., Kohno H. Cretinism with combined hormone deficiency caused by a mutation in PIT-1 gene. Nat. Genet. 1992, 1: 56–58.
Craft W.H., Underwood L.E., Van Wyk J.J. High incidence of perinatal insult in children with idiopathic hypopituitarism. J. Pediatr. 1980, 96: 397–402.
Rona R.J., Tanner J.M. Aetiology of idiopathic growth hormone deficiency in England and Wales. Arch. Dis. Child. 1997, 52: 197–208.
Kikuchi K., Fujisawa I., Momoi T., Yamanaka C., Kaji M., Nakano Y., Konishi J., Mikawa H., Sudo M. Hypothalamic-pituitary function in growth hormonedeficient patients with pituitary stalk transection. J. Clin. Endocrinol. Metab. 1988, 67: 817–823.
Kashio Y., Chicara K., Kaji H., Minamitani N., Kita T., Okimura Y., Abe H., Iwasaki J., Fujita T. Presence of growth hormone-releasing factor-like immunoreactivity in human cerebrospinal fluid. J. CIin. Endocrinol. Metab. 1985, 60: 396–398.
Maghnie M., Triulzi F., Larizza D., Preti P., Priora C., Scotti G., Severi F. Hypothalamic pituitary disfunction in growth hormone deficient patients with pituitary abnormalities. J. Clin. Endocrinol. Metab. 1991, 173: 79–83.
Abrahams J.J., Trefelner E., Boulware S.D. Idiopatic Growth Hormon deficiency: MRI findings in 35 patients. Am. J. Neuroradiol. 1991, 12: 155–160.
Pellini C., Di Natale B., De Angelis R., Bressani N., Scotti G., Triulzi F., Chiumello G. Growth hormone deficiency In children: role of magnetic resonance imaging in assessing aetiopathogenesis and prognosis in idiopathic hypopituitarism. Eur. J. Pediatr. 1990, 149: 536–541.
Smeth M.H., De Zeger F., Vandershueren-Lodeweyckx M., Marchal G. Infantile hypopituitarism: etiologic variability evidenced by MRI. Eur. Radiol. 1992, 2: 57–61.
Stanhope R., Hindmarsh P., Kendall B., Brook C.G. High resolution CT scanning of the pituitary gland in growth disorders. Acta Paediatr. Scand. 1986, 75: 779–786.
Kaplan S.A. Growth and growth hormone disorders of the anterior pituitary. In: Kaplan S.A. (Ed.), Clinical Pediatric Endocrinology. W.B. Saunders, Philadelphia, 1990, pp. 1–62.
De Angelis R., Di Natale B., Lukezik M., Chiumello G. Il deficit idiopatico di ormone della crescita: nuove ipotesi. Medico e Bambino, 1993, p. 92–94.
Gerard F., Le Donarin C., Le Donarin M.N. Mapping of the early primordium in quail chick chimeras. The prosencephalic neural plate and neural folds implications for the genesis of cephalic human congenital abnormalities. Dev. Biol. 1987, 120: 198–214.
Sakamoto Y., Takahashi M., Korogi Y., Bussaka H. Ushio Y. Normal and abnormal pituitary glands: Gadopentetate dimeglumine-enhanced MR imaging. Radiology 1991, 178: 441–445.
Page R.B., Bergland R.M. Pituitary vasculature. In: Allen M.B., Mahesh V.B. (Eds.), The Pituitary: A Current Review. Academic Press, New York, 1977, vol. I, p. 9–17.
Gorczyca W., Hardy J. Arterial supply of the human anterior pituitary gland. Neurosurgery 1987, 20: 369–378.
Tien R.D. Sequence of enhancement of various portions of the pituitary gland on gadolinium-enhanced MR images: correlation with regional blood supply. Am. J. Roentgenol. 1992, 158: 651–654.
Yuh W.T., Fischer D.J., Nguyen H.D., Taki E.T., Gao F., Simonson T.M., Schlechte J.A. Sequential MR enhancement pattern in normal pituitary gland and in pituitary adenoma. Am. J. Roentgenol. 1994, 15: 101–108.
Manfrè L., Rosato F., Midiri M., Jannì A., Lagalla R. Neuroradiologia funzionale della ghiandola ipofisaria: valutazione delle possibilità offerte dalla RM sequenziale nel normale e nel patologico. Riv. Ital. Neuroradiol. 1995, 8: 645–656.
Argyropoulou M., Perignon F., Brauner R., Brunelle F. Magnetic resonance imaging in the diagnosis of growth hormon deficiency. J. Pediatr. 1992, 120: 886–891.
Maghnie M., Genovese E., Aricò M., Villa A., Beluffi G., Campani R., Severi F. Evolving pituitary hormone deficiency is associated with pituitary vasculopathy: dynamic MR study in children with hypopituitarism, diabetes insipidus and Lagerhans cell histiocytosis. Pediatr. Radiol. 1994, 193: 493–499.
Miki Y., Matsuo M., Nishizawa S., Kuroda Y., Keyaki A., Makita Y., Kawamura J. Pituitary adenomas and normal pituitary tissue: enhancement patterns on Gadopentetate-enhanced MR imaging. Radiology 1990, 177: 35–38.
Tanner J.M., Whitehouse R.H., Takaishi M. Standards from birth to maturity for height, weight, height velocity, and weight velocity: British children, 1965. I. Arch. Dis. Child. 1966, 41: 454–471.
Tanner J.M., Whitehouse R.H., Takaishi M. Standards from birth to maturity for height, weight, height velocity, and weight velocity: British children, 1965. II. Arch. Dis. Child. 1966, 41: 613–635.
Tanner J.M., Whitehouse R.H., Cameron N., Marshall W.A., Healy M.J.R., Goldestein H. Assessment of skeletal maturity and prediction of adult height (TW2 method). Academic Press Ltd., London, 1988.
Marshall W.A., Tanner J.M. Variations in pattern of pubertal changes in girls. Arch. Dis. Child. 1969, 44: 291–303.
Marshall W.A., Tanner J.M. Variations in the pattern of pubertal changes in boys. Arch. Dis. Child. 1970, 45: 13–23.
Ghigo E., Cappa M. Utilità del GHRH nella diagnostica della bassa statura. Rivista Farmac. 1992, 16 (7/8).
Tsunoda A., Okuda O., Sato K. MR height of the pituitary gland as a function of age and sex: especially physiological hypertrophy in adolescence and in climaterium. Am. J. Neuroradiol. 1997, 18: 551–554.
Manfrè L., Maggio C., Giuffrè M., De Maria M., Liotta A., Lagalla R. Idiopathic Growth Hormone Deficiency. Use of fast framing dynamic MRI. Int. J. Neuroradiol. 1996, 2: 473–497.
Manfrè L., Midiri M., Rosato F., Jannì A., Lagalla R. Perfusion MR imaging in normal and abnormal pituitary gland: a preliminary study. Clin. Imaging 1997, 21: 311–318.
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Liotta, A., Maggio, C., Giuffrè, M. et al. Sequential contrast-enhanced magnetic resonance imaging in the diagnosis of growth hormone deficiencies. J Endocrinol Invest 22, 740–746 (1999). https://doi.org/10.1007/BF03343638
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DOI: https://doi.org/10.1007/BF03343638