medwireNews: Less than 10% of brain magnetic resonance imaging (MRI) scans in children with isolated growth hormone deficiency (GHD) reveal a pathological cause, say researchers.
“Routinely obtaining MRI scans in all children with [isolated] GHD may not be an effective use of healthcare resources, and we suggest that it is likely to lead to children being subjected to unnecessary testing”, the team writes in Hormone Research in Paediatrics.
Routine MRI in 192 children with GHD admitted to three Israeli centres over 10 years revealed pathological findings in the hypothalamic–pituitary region in just 15 (7.8%) cases, report Asaf Oren (Dana-Dwek Children’s Hospital, Tel-Aviv, Israel) and study co-authors.
The most common finding was hypoplastic anterior hypophysis, in nine children. Other findings included ectopic posterior hypophysis in four children, empty sella in two and interrupted stalk and Rathke cleft cyst in one child each.
In addition, six children had Chiari type 1 malformation, including one who also had hypoplastic anterior hypophysis. No child had an intracranial tumour.
Of note, the children with pituitary abnormalities had a significantly lower height standard deviation score than those without, at –2.3 versus –1.6, as well as a lower mean peak stimulated GH level, at 4.4 versus 5.7 µg/L.
The researchers therefore suggest that “MRI may be better recommended only to those children with low peak GH level or profound height deficit.”
They caution that there was overlap between the groups, however. At a GH cutoff of 4.0 µg/L, 24.0% of children below versus 5.4% of those above the threshold had pathological findings. A higher cutoff of 6.9 µg/L was required to identify all children with pituitary abnormalities.
“From a healthcare utilization perspective, more limited use of a brain MRI in the evaluation of [isolated] GHD will yield substantial cost savings”, say Oren and colleagues.
They add: “Additional concerns regarding performing nonessential MRI studies are related to the use of gadolinium contrast in pituitary-dedicated protocols and the need for sedation in younger children.”
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Horm Res Paediatr 2020; doi:10.1159/000509366