Incidence and Outcomes of Pituitary Microadenomas in Children with Short Stature/Growth Hormone Deficiency

Abstract

Background/Aims: Patients with short stature (SS)/growth hormone deficiency (GHD) and precocious puberty (PP) undergo brain MRI to evaluate for structural brain abnormalities or pituitary lesions, and pituitary microadenomas are a common finding. Theoretically, a mass effect from these lesions could cause GHD and growth hormone treatment could cause them to enlarge, but they should not cause PP, at least in females. Methods: We investigated if pituitary microadenomas cause GHD by comparing their incidence in patients with SS/GHD to that in females with PP. We performed a retrospective chart review of patients with these disorders who had a brain MRI between 2000 and 2013. Results: The incidence of microadenoma was high in both groups, 18.5% for SS (n = 346) and 21.1% for PP females (n = 194), but did not differ between groups (p = 0.46). In patients with microadenomas, repeat imaging showed resolution in 58% (SS, n = 33) and 67% (PP females, n = 21). Importantly, none of the lesions grew, even in patients treated with growth hormone. Conclusions: Pituitary microadenomas are common in children with GHD/SS and PP, but it does not appear that they are a cause of GHD. They appear to be of limited clinical significance and should not be considered a contraindication to growth hormone therapy.

MRI Protocol for Pituitary Assessment in Children with Growth or Puberty Disorders—Is Gadolinium Contrast Administration Actually Needed?

“…Focal lesions of the pituitary gland in the population of healthy children are unusual, and although in children with hormonal disorders this is also a rare phenomenon, it is more common than in healthy individuals [ 1 ].…”

“…One of the causes of hormone-related disorders in childhood physical development may be the presence of a lesion in the pituitary gland region. After endocrinological assessment, pituitary changes exclusion is one of the most important elements of diagnostic management of growth and puberty disorders (GPDs) in children [ 1 , 2 ]. The method of choice for pituitary assessment is magnetic resonance imaging (MRI) [ 2 ].…”

Contrast-free MRI Protocol for Pituitary Assessment in Children with Growth or Puberty Disorders: A Practical Approach.

“…Focal lesions of the pituitary gland in the population of healthy children are unusual, and although in children with hormonal disorders this is also a rare phenomenon, it is more common than in healthy individuals. [1] Studies on pituitary changes in the pediatric population were for a long time unavailable. Only in 2019 did Souteiro et al in a study on children with almost 16 000 patients examine the occurrence of all pituitary abnormalities with an incidence rate of 257/100,000 patients.…”

“…However, in light of recent studies incidentalomas should not be considered a contraindication to hormone therapy. [1] Consequently, the identification of MA-like tumors in a non-contrast examination should not change clinical management of pediatric patients with hormonal disorders, therefore the diagnosis of MA does not need to be confirmed by a post-contrast MRI. Following this lead, one can come to interesting conclusions: even in the case of an incidentaloma not visible in the non-contrast examination, its potential detection after GBCA administration does not affect the clinical management of children with hormonal disorders.…”

“…After endocrinological assessment, pituitary changes exclusion is one of the most important elements of diagnostic management of growth and puberty disorders (GPD) in children. [1], [2] The method of choice for pituitary assessment is magnetic resonance imaging (MRI). [2] Actually, the MRI protocol of the pituitary gland includes images before and after administration of gadolinium-based contrast agent (GBCA), [2], [3] which according to current knowledge is not neutral to the human body.…”