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Prevalence of brain MRI findings in children with nonacquired growth hormone deficiency: a systematic review and meta-analysis

  • Paediatric Neuroradiology
  • Published:
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Abstract

Purpose

To verify and integrate the prevalence and phenotype of abnormalities in the sellar region in patients with growth hormone deficiency (GHD) using MRI data.

Methods

We searched PubMed and EMBASE up to December 14, 2020. The inclusion criteria were as follows: (1) pediatric patients diagnosed with nonacquired GHD and (2) detailed data sufficient to assess the proportion of sellar and parasellar abnormalities on brain MRI scans. Finally, thirty-two studies with 39,060 children (mean or median age, 3.4–14.1 years) were included. The number and type of MRI findings from all included studies were pooled by two authors. The heterogeneity across studies was evaluated with the Q test or the inconsistency index (I2) statistic. Subgroup analyses were performed according to the type of GHD (isolated GHD [IGHD] vs. multiple pituitary hormone deficiency [MPHD]), MRI magnet, geographical region, and cutoff serum growth hormone (GH) level.

Results

The pooled proportion of sellar and parasellar abnormalities was 58.0% (95% CI, 47.1–68.6%; I2, 98.2%). The MPHD group showed a higher proportion of sellar and parasellar abnormalities and pituitary stalk interruption syndrome than the IGHD group (91.4% vs. 40.1%, P<0.001; 65.3% vs. 20.1%, P<0.001). The patients in studies with low peak GH levels on stimulation tests were more associated with severe MR abnormalities (cutoff GH ≤ 5 μg/l vs. cutoff GH = 10 μg/l; 72.8 % vs. 38.0%; P<0.001).

Conclusion

The types and incidence of MRI abnormalities of the sellar region differ significantly between the IGHD and MPHD groups.

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Abbreviations

GH:

Growth hormone

GHD:

Growth hormone deficiency

CNS:

Central nervous system

IGHD:

Isolated growth hormone deficiency

MPHD:

Multiple pituitary hormone deficiency

IAPH:

Isolated anterior pituitary hypoplasia

EPP:

Isolated ectopic posterior pituitary

PSIS:

Pituitary stalk interruption syndrome

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Acknowledgments

We thank Ji Sung Lee (Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea) for the statistical assistance.

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Authors and Affiliations

  1. Department of Radiology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Republic of Korea

    Jisun Hwang, Sang Won Jo, Seun Ah Lee & Suk-Ki Chang

  2. Department of Pediatrics, Dongtan Sacred Heart Hospital, Hallym University Medical Center, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Republic of Korea

    Eun Byul Kwon

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Hwang, J., Jo, S.W., Kwon, E.B. et al. Prevalence of brain MRI findings in children with nonacquired growth hormone deficiency: a systematic review and meta-analysis. Neuroradiology 63, 1121–1133 (2021). https://doi.org/10.1007/s00234-021-02665-3

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