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Pituitary Gland Imaging

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Growth Hormone Deficiency

Abstract

MRI imaging is the technique of choice in the diagnosis of children with hypopituitarism. Marked differences in MRI pituitary gland morphology suggest different etiologies of growth hormone deficiency (GHD) and different prognoses. Pituitary stalk agenesis and ectopic posterior pituitary (EPP) are specific markers of permanent GHD, and patients with these MRI findings show a different clinical and endocrine outcome compared to those with isolated hypoplastic pituitary or normal pituitary anatomy. T2 DRIVE images aid in the identification of the pituitary stalk without the use of contrast medium administration. Future developments in imaging techniques will undoubtedly reveal additional insights. Mutations in a number of genes have been associated with pituitary dysfunction and abnormal pituitary gland development; the correlation of genetic mutations to endocrine and MRI phenotypes has improved our knowledge of pituitary development.

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References

  1. Maghnie M, Ghirardello S, Genovese E. Magnetic resonance imaging of the hypothalamus-pituitary unit in children suspected of hypopituitarism: who, how and when to investigate. J Endocrinol Invest. 2004;27:496–509.

    Article  CAS  PubMed  Google Scholar 

  2. Di Iorgi N, Allegri AE, Napoli F, Bertelli E, Olivieri I, Rossi A, Maghnie M. The use of neuroimaging for assessing disorders of pituitary development. Clin Endocrinol (Oxf). 2012;76:161–76.

    Article  Google Scholar 

  3. Fujisawa I, Kikchi K, Nishimura K, Togashi K, Itoh K, Noma S, Minami S, Sagoh T, Hiraoka T, Momoi T. Transection of the pituitary stalk: development of an ectopic posterior lobe associated with MR imaging. Radiology. 1987;165:487–9.

    Article  CAS  PubMed  Google Scholar 

  4. Kikuchi K, Fujisawa I, Momoi T, Yamanaka C, Kaji M, Nakano Y, Konishi J, Mikawa H, Sudo M. Hypothalamic-pituitary function in growth hormone-deficient patients with pituitary transection. J Clin Endocrinol Metab. 1988;67:817–23.

    Article  CAS  PubMed  Google Scholar 

  5. 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;20:229–35.

    Article  CAS  PubMed  Google Scholar 

  6. Maghnie M, Triulzi F, Larizza D, Preti P, Priora C, Scotti G, Severi F. Hypothalamic-pituitary dysfunction in growth hormone-deficient patients with pituitary abnormalities. J Clin Endocrinol Metab. 1991;72:79–83.

    Article  Google Scholar 

  7. Triulzi F, Scotti G, di Natale B, Pellini C, Lukezic M, Scognamiglio M, Chiumello G. Evidence of a congenital midline brain anomaly in pituitary dwarfs: a magnetic resonance imaging study in 101 patients. Pediatrics. 1994;93:409–16.

    CAS  PubMed  Google Scholar 

  8. Pinto G, Netchine I, Sobrier ML, Brunelle F, Souberbielle JC, Brauner R. Pituitary stalk interruption syndrome: a clinical-biological-genetic assessment of its pathogenesis. J Clin Endocrinol Metab. 1997;82:3450–4.

    CAS  PubMed  Google Scholar 

  9. Maghnie M, Genovese E, Villa A, Spagnolo L, Campan R, Severi F. Dynamic MRI in the congenital agenesis of the neural pituitary stalk syndrome: the role of the vascular pituitary stalk in predicting residual anterior pituitary function. Clin Endocrinol (Oxf). 1996;45:281–90.

    Article  CAS  Google Scholar 

  10. Arrigo T, De Luca F, Maghnie M, Blandino A, Lombardo F, Messina MF, Wasniewska M, Ghizzoni L, Bozzola M. Relationships between neuroradiological and clinical features in apparently idiopathic hypopituitarism. Eur J Endocrinol. 1998;139:84–8.

    Article  CAS  PubMed  Google Scholar 

  11. Chen S, Leger J, Garel C, Hassan M, Czernichow P. Growth hormone deficiency with ectopic neurohypophysis: anatomical variations and relationship between the visibility of the pituitary stalk asserted by magnetic resonance imaging and anterior pituitary function. J Clin Endocrinol Metab. 1999;84:2408–13.

    Article  CAS  PubMed  Google Scholar 

  12. Maghnie M, Ambrosini L, Cappa M, Pozzobon G, Ghizzoni L, Ubertini MG, di Iorgi N, Tinelli C, Pilia S, Chiumello G, Lorini R, Loche S. Adult height in patients with permanent growth hormone deficiency with and without multiple pituitary hormone deficiencies. J Clin Endocrinol Metab. 2006;91:2900–5.

    Article  CAS  PubMed  Google Scholar 

  13. Maghnie M, Strigazzi C, Tinelli C, Autelli M, Cisternino M, Loche S, Severi F. Growth hormone (GH) deficiency (GHD) of childhood onset: reassessment of GH status and evaluation of the predictive criteria for permanent GHD in young adults. J Clin Endocrinol Metab. 1999;84:1324–8.

    Article  CAS  PubMed  Google Scholar 

  14. Murray PG, Hague C, Fafoula O, Gleeson H, Patel L, Banerjee I, Raabe AL, Hall CM, Wright NB, Amin R, Clayton PE. Likelihood of persistent GH deficiency into late adolescence: relationship to the presence of an ectopic or normally sited posterior pituitary gland. Clin Endocrinol (Oxf). 2009;71:215–9.

    Article  CAS  Google Scholar 

  15. Di Iorgi N, Morana G, Gallizia AL, Maghnie M. Pituitary gland imaging and outcome. Endocr Dev. 2012;23:16–29.

    Article  PubMed  Google Scholar 

  16. Vossough A, Nabavizadeh SA. Functional imaging based diagnostic strategy: intra-axial brain masses. In: Scott HF, Feroze BM, editors. Functional neuroradiology, principles and clinical application. New York: Springer; 2011. p. 197–220.

    Chapter  Google Scholar 

  17. Rossi A, Gandolfo C, Morana G, Severino M, Garrè ML, Cama A. New MR sequences (diffusion, perfusion, spectroscopy) in brain tumours. Pediatr Radiol. 2010;40:999–1009.

    Article  PubMed  Google Scholar 

  18. Elster AD. Modern imaging of the pituitary. Radiology. 1993;187:1–14.

    Article  CAS  PubMed  Google Scholar 

  19. Elster AD, Chen MTM, Williams III DW, Key LL. Pituitary gland: MR imaging of physiologic hypertrophy in adolescence. Radiology. 1990;174:681–5.

    Article  CAS  PubMed  Google Scholar 

  20. Bonneville F, Cattin F, Marsot-Dupuch K, Dormonnt D, Bonneville JF, Chiras J. T1 signal hyperintensity in the sellar region: spectrum of findings. Radiographics. 2006;26:93–113.

    Article  PubMed  Google Scholar 

  21. Tortori-Donati P, Rossi A, Biancheri R. Sellar and suprasellar disorders. In: Tortori-Donati P, editor. Pediatric neuroradiology. Berlin: Springer; 2005. p. 855–91.

    Chapter  Google Scholar 

  22. Cox TD, Elster AD. Normal pituitary gland: changes in shape, size, and signal intensity during the 1st year of life at MR imaging. Radiology. 1991;179:721–4.

    Article  CAS  PubMed  Google Scholar 

  23. Dietrich RB, Lis LE, Greensite FS, Duane P. Normal MR appearance of the pituitary gland in the first 2 years of life. AJNR Am J Neuroradiol. 1995;16:1413–9.

    CAS  PubMed  Google Scholar 

  24. 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 climacterium. AJNR Am J Neuroradiol. 1997;18:551–4.

    CAS  PubMed  Google Scholar 

  25. Fink AM, Vidmar S, Kumbla S, Pedreira CC, Kanumakala S, Williams C, Carlin JB, Cameron FJ. Age-related pituitary volumes in prepubertal children with normal endocrine function: volumetric magnetic resonance data. J Clin Endocrinol Metabol. 2005;90:3274–8.

    Article  CAS  Google Scholar 

  26. Marziali S, Gaudiello F, Bozzao A, Scirè G, Ferone E, Colangelo V, Simonetti A, Boscherini B, Floris R, Simonetti G. Evaluation of anterior pituitary gland volume in childhood using three-dimensional MRI. Pediatr Radiol. 2004;34:547–51.

    Article  PubMed  Google Scholar 

  27. Takano K, Utsunomiya H, Ono H, Ohfu M, Okazaki M. Normal development of the pituitary gland: assessment with three-dimensional MR volumetry. AJNR Am J Neuroradiol. 2004;20:312–5.

    Google Scholar 

  28. Maghnie M, Lindberg A, Koltowska-Häggström M, Ranke MB. Magnetic resonance imaging of CNS in 15,043 children with GH deficiency in KIGS (Pfizer International Growth Database). Eur J Endocrinol. 2013;168(2):211–7.

    Article  CAS  PubMed  Google Scholar 

  29. Secco A, di Iorgi N, Napoli F, Calandra E, Ghezzi M, Frassinetti C, Parodi S, Casini MR, Lorini R, Loche S, et al. The glucagon test in the diagnosis of growth hormone deficiency in children with short stature younger than 6 years. J Clin Endocrinol Metabol. 2009;94:4251–7.

    Article  CAS  Google Scholar 

  30. Argyropoulou M, Perignon F, Brunelle F, Brauner R, Rappaport R. Height of normal pituitary gland as a function of age evaluated by magnetic resonance imaging in children. Pediatr Radiol. 1991;21:247–9.

    Article  CAS  PubMed  Google Scholar 

  31. 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;34:189–92.

    Article  CAS  PubMed  Google Scholar 

  32. Abrahams JJ, Trefelner E, Boulware SD. Idiopathic growth hormone deficiency: MR findings in 35 patients. Am J Neuroradiol. 1991;12:155–60.

    CAS  PubMed  Google Scholar 

  33. Melo ME, Marui S, Carvalho LR, Arnhold IJ, Leite CC, Mendonca BB, Knoepfelmacher M. Hormonal, pituitary magnetic resonance, LHX4 and HESX1 evaluation in patients with hypopituitarism and ectopic posterior pituitary lobe. Clin Endocrinol (Oxf). 2007;66:95–102.

    CAS  Google Scholar 

  34. Argyropoulou M, Perignon F, Brauner R, Brunelle F. Magnetic resonance imaging in the diagnosis of growth hormone deficiency. J Pediatr. 1992;120:886–91.

    Article  CAS  PubMed  Google Scholar 

  35. Nagel BH, Palmbach M, Petersen D, Ranke MB. Magnetic resonance images of 91 children with different causes of short stature: pituitary size reflects growth hormone secretion. Eur J Pediatr. 1997;156:758–63.

    Article  CAS  PubMed  Google Scholar 

  36. Kornreich L, Horev G, Lazar L, Josefsberg Z, Pertzelan A. MR findings in hereditary isolated growth hormone deficiency. Am J Neuroradiol. 1997;18:1743–7.

    CAS  PubMed  Google Scholar 

  37. Hamilton J, Chitayat D, Blaser S, Cohen LE, Phillips 3rd JA, Daneman D. Familial growth hormone deficiency associated with MRI abnormalities. Am J Med Genet. 1998;80:128–32.

    Article  CAS  PubMed  Google Scholar 

  38. Arifa N, Leger J, Garel C, Czernichow P, Hassan M. Cerebral anomalies associated with growth hormone insufficiency in children: major markers for diagnosis? Arch Pediatr. 1999;6:14–21.

    Article  CAS  PubMed  Google Scholar 

  39. Bozzola M, Mengarda F, Sartirana P, Tato L, Chaussain JL. Long-term follow-up evaluation of magnetic resonance imaging in the prognosis of permanent GH deficiency. Eur J Endocrinol. 2000;143:493–6.

    Article  CAS  PubMed  Google Scholar 

  40. Osorio MG, Marui S, Jorge AA, Latronico AC, Lo LS, Leite CC, Estefan V, Mendonca BB, Arnhold IJ. Pituitary magnetic resonance imaging and function in patients with growth hormone deficiency with and without mutations in GHRH-R, GH-1, or PROP-1 genes. J Clin Endocrinol Metab. 2002;87(11):5076–84.

    Article  CAS  PubMed  Google Scholar 

  41. Arends NJ, V d Lip W, Robben SG, Hokken-Koelega AC. MRI findings of the pituitary gland in short children born small for gestational age (SGA) in comparison with growth hormone-deficient (GHD) children and children with normal stature. Clin Endocrinol (Oxf). 2002;57:719–24.

    Article  CAS  Google Scholar 

  42. Mehta A, Hindmarsh PC, Mehta H, Turton JP, Russell-Eggitt I, Taylor D, Chong WK, Dattani MT. Congenital hypopituitarism: clinical, molecular and neuroradiological correlates. Clin Endocrinol (Oxf). 2009;71(3):376–82.

    Article  Google Scholar 

  43. Acharya SV, Gopal RA, Lila A, Sanghvi DS, Menon PS, Bandgar TR, Shah NS. Phenotype and radiological correlation in patients with growth hormone deficiency. Indian J Pediatr. 2011;78(1):49–54.

    Article  PubMed  Google Scholar 

  44. Jagtap VS, Acharya SV, Sarathi V, Lila AR, Budyal SR, Kasaliwal R, Sankhe SS, Bandgar TR, Menon PS, Shah NS. Ectopic posterior pituitary and stalk abnormality predicts severity and coexisting hormone deficiencies in patients with congenital growth hormone deficiency. Pituitary. 2012;15(2):243–50.

    Article  CAS  PubMed  Google Scholar 

  45. Deal C, Hasselmann C, Pfäffle RW, Zimmermann AG, Quigley CA, Child CJ, Shavrikova EP, Cutler Jr GB, Blum WF. Associations between pituitary imaging abnormalities and clinical and biochemical phenotypes in children with congenital growth hormone deficiency: data from an international observational study. Horm Res Paediatr. 2013;79(5):283–92.

    Article  CAS  PubMed  Google Scholar 

  46. Naderi F, Eslami SR, Mirak SA, Khak M, Amiri J, Beyrami B, Shekarchi B, Poureisa M. Effect of growth hormone deficiency on brain MRI findings among children with growth restrictions. J Pediatr Endocrinol Metab. 2015;28(1–2):117–23.

    CAS  PubMed  Google Scholar 

  47. Deillon E, Hauschild M, Faouzi M, Stoppa-Vaucher S, Elowe-Gruau E, Dwyer A, Theintz GE, Dubuis JM, Mullis PE, Pitteloud N, Phan-Hug F. Natural history of growth hormone deficiency in a pediatric cohort. Horm Res Paediatr. 2015;83(4):252–61.

    Article  CAS  PubMed  Google Scholar 

  48. Argente J, Flores R, Gutiérrez-Arumí A, Verma B, Martos-Moreno GÁ, Cuscó I, Oghabian A, Chowen JA, Frilander MJ, Pérez-Jurado LA. Defective minor spliceosome mRNA processing results in isolated familial growth hormone deficiency. EMBO Mol Med. 2014;6(3):299–306.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Werder EA, Zachmann M, Wichmann W, Valavanis A. Neurohypophyseal ectopy in growth hormone insufficiency. Horm Res. 1989;31:210–2.

    Article  CAS  PubMed  Google Scholar 

  50. Genovese E, Maghnie M, Beluffi G, Villa A, Sammarchi L, Severi F, Campani R. Hypothalamic-pituitary vascularization in pituitary stalk transection syndrome: is the pituitary stalk really transected? The role of gadolinium-DTPA with spin-echo T1 imaging and turbo-FLASH technique. Pediatr Radiol. 1997;27:48–53.

    Article  CAS  PubMed  Google Scholar 

  51. Cervantes LF, Altman NR, Medina LS. Case 102: pituitary aplasia. Radiology. 2006;241:936–8.

    Article  PubMed  Google Scholar 

  52. Seeger JF. Normal variations of the skull and its content. In: Zimmerman RA, Gibby WA, Carmody RF, editors. Neuroimaging, clinical and physical principles. New York: Springer; 2000. p. 415–89.

    Google Scholar 

  53. Cacciari E, Zucchini S, Ambrosetto P, et al. Empty sella in children and adolescents with possible hypothalamic-pituitary disorders. J Clin Endocrinol Metab. 1994;78:767–71.

    CAS  PubMed  Google Scholar 

  54. Degnan AJ, Levy LM. Pseudotumor cerebri: brief review of clinical syndrome and imaging findings. AJNR Am J Neuroradiol. 2011;32:1986–93.

    Article  CAS  PubMed  Google Scholar 

  55. Lenz AM, Root AW. Empty sella syndrome. Pediatr Endocrinol Rev. 2012;9:710–5.

    PubMed  Google Scholar 

  56. Morana G, Maghnie M, Rossi A. Pituitary tumors: advances in neuroimaging. Endocr Dev. 2010;17:160–74.

    Article  CAS  PubMed  Google Scholar 

  57. Di Iorgi N, Morana G, Napoli F, Allegri AE, Rossi A, Maghnie M. Management of diabetes insipidus and adipsia in the child. Best Pract Res Clin Endocrinol Metab. 2015;29:415–36.

    Article  PubMed  Google Scholar 

  58. Di Iorgi N, Morana G, Maghnie M. Pituitary stalk thickening on MRI: when is the best time to re-scan and how long should we continue re-scanning for? Clin Endocrinol (Oxf). 2015. doi:10.1111/cen.12769. (Epub ahead of print)

    Google Scholar 

  59. Maghnie M, Cosi G, Genovese E, Manca-Bitti ML, Cohen A, Zecca S, Tinelli C, Gallucci M, Bernasconi S, Boscherini B, Severi F, Aricò M. Central diabetes insipidus in children and young adults. N Engl J Med. 2000;343:998–1007.

    Article  CAS  PubMed  Google Scholar 

  60. Di Iorgi N, Allegri AE, Napoli F, Calcagno A, Calandra E, Fratangeli N, Vannati M, Rossi A, Bagnasco F, Haupt R, Maghnie M. Central diabetes insipidus in children and young adults: etiological diagnosis and long-term outcome of idiopathic cases. J Clin Endocrinol Metab. 2014;99:1264–72.

    Article  PubMed  Google Scholar 

  61. Alatzoglou KS, Dattani MT. Genetic causes and treatment of isolated growth hormone deficiency-an update. Nat Rev Endocrinol. 2010;6:562–76.

    Article  CAS  PubMed  Google Scholar 

  62. Correa FA, Trarbach EB, Tusset C, Latronico AC, Montenegro LR, Carvalho LR, Franca MM, Otto AP, Costalonga EF, Brito VN, Abreu AP, Nishi MN, Jorge AAL, Arnhold IJP, Sidis Y, Pitteloud N, Mendonca BB. FGFR1 and PROKR2 rare variants found in patients with combined pituitary hormone deficiencies. Endocr Connect. 2015;4(2):100–7.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Li G, Shao P, Sun X, Wang Q, Zhang L. Magnetic resonance imaging and pituitary function in children with panhypopituitarism. Horm Res Paediatr. 2010;73(3):205–9.

    Article  PubMed  Google Scholar 

  64. Pfaeffle RW, Hunter CS, Savage JJ, Duran-Prado M, Mullen RD, Neeb ZP, Eiholzer U, Hesse V, Haddad NG, Stobbe HM, Blum WF, Weigel JF, Rhodes SJ. Three novel missense mutations within the LHX4 gene are associated with variable pituitary hormone deficiencies. J Clin Endocrinol Metab. 2008;93(3):1062–71.

    Article  CAS  PubMed  Google Scholar 

  65. Hilal L, Hajaji Y, Vie-Luton MP, Ajaltouni Z, Benazzouz B, Chana M, Chraïbi A, Kadiri A, Amselem S, Sobrier ML. Unusual phenotypic features in a patient with a novel splice mutation in the GHRHR gene. Mol Med. 2008;14(5–6):286–92.

    CAS  PubMed  PubMed Central  Google Scholar 

  66. Secco A, Di Iorgi N, Maghnie M. Structural abnormalities in congenital growth hormone deficiency. In: Ho K, editor. Growth hormone related diseases and therapy: a molecular and physiological perspective for the clinician. New York: Springer; 2011. p. 103–35.

    Chapter  Google Scholar 

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Di Iorgi, N., Morana, G., Napoli, F., Rossi, A., Maghnie, M. (2016). Pituitary Gland Imaging. In: Cohen, L. (eds) Growth Hormone Deficiency. Springer, Cham. https://doi.org/10.1007/978-3-319-28038-7_10

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