Magnetic resonance imaging in assessing the condition of the pituitary gland in children with growth retardation

BACKGROUND: The pituitary gland is an endocrine gland that plays a crucial role in the regulation of metabolism, physical and sexual development. Modern medical imaging techniques allow the study of changes in the hypothalamic-pituitary region in children with low physical development [1–3].

AIM: The aim of the study was to investigate the state of the hypothalamic-pituitary region in children with different forms of nanism using magnetic resonance imaging.

MATERIALS AND METHODS: The study included 102 boys and 96 girls with complaints of growth retardation. Magnetic resonance imaging of the brain with targeted studies of the pituitary region of children and adolescents aged 8–15 years was studied. Using a high-field magnetic resonance imager, the brain was scanned in the axial, coronal, and sagittal planes using standard modes and targeted examination of the pituitary region using T1- and T2-weighted pulse sequences with a slice thickness of 2.0 mm. Inclusions in the pituitary gland requiring differential diagnosis betwe en adenoma and Rathke’s cleft cyst were imaged with intravenous contrast. The physical development of the children was evaluated using the AntroPlus computer program. The significance of differences between groups was determined by the confidence interval; differences were considered significant at p <0.05.

RESULTS: Analysis of the obtained data shows that 92.0% of children and adolescents with idiopathic stunting have a standard deviation of growth from –2.0 to –3.0. In these children, hypoplasia of the pituitary gland was found in 36.4% of cases, residual structures of Rathke's cleft cyst in 16.5%, and inactive pituitary adenoma in 4.2%. Normal structure of the pituitary gland was found in the remaining children. In the group of patients with growth hormone deficiency, children with standard deviation of growth coefficient from –3.0 to –4.0 are more frequent (52.6% of patients), and 31.4% of boys and girls have growth retardation more than –4 σ. In these children, in addition to hypothalamic-pituitary masses and hypoplasia of the adenohypophysis, magnetic resonance imaging revealed in 26.7% of cases (including 83.4% of boys and 16.6% of girls) an abnormality of pituitary development in the form of a triad: hypoplasia of the adenohypophysis, shortened pituitary pedicle, and ectopia of the neurohypophysis. In the group of patients with growth retardation due to the presence of hereditary syndromes, 32.7% of those studied had a coefficient of standard deviation of growth between –2.0 and –3.0, and 33.4% had a coefficient of standard deviation of growth between –3.0 and –4.0. In children with more severe growth retardation, magnetic resonance signs of empty sella (22.6%) and hypoplasia of the pituitary gland (34.8%) were more frequently visualized.

CONCLUSIONS: Magnetic resonance imaging is the primary method for evaluating the pituitary gland [4]. Children with idiopathic stunting exhibit a coefficient of standard deviation of growth that is 5.4 times less frequent than that observed in boys and girls from other groups. In the group of children with growth hormone deficiency, the coefficient of standard deviation from –3.0 to –4.0 is 1.6 times more frequent than in those with hereditary syndromes. One-third of children with pituitary stunting who exhibited a growth deficit greater than –4 σ exhibited a pituitary developmental anomaly in the form of a triad (hypoplasia of the adenohypophysis, shortening of the pituitary gyrus, and ectopia of the neurohypophysis). In contrast, no such anomaly was found in the other groups. The coefficient of standard deviation of growth greater than –4 was found in single cases.