J Pediatr Endocr Met 2015; 28(1-2): 117–123
Fariba Naderi, Samira Rajabi Eslami, Sohrab Afshari Mirak*, Mohammad Khak, Jalaladin Amiri, Bahram Beyrami, Babak Shekarchi and Masoud Poureisa
Effect of growth hormone deficiency on brain MRI findings among children with growth restrictions Introduction
Abstract Objectives: Growth hormone deficiency (GHD) is a major problem among children with short stature. In this study, the role of brain magnetic resonance imaging (MRI) in defining the underlying defects among short children with GHD is evaluated. Methods: In a cross-sectional study, data of 158 children were evaluated. Growth hormone (GH) levels were measured using stimulating tests and brain MRI with gadolinium contrast was applied, as well. Results: Some 25.3% of patients had GHD with a mean age of 8.01 ± 3.40 years. MRI results showed 35 as normal, four with pituitary hypoplasia, and one with microadenoma. The MRI results were significantly associated with GH levels and presence of other endocrine disorders. There was a significant association between prenatal disorders and patients’ bone age delay. Conclusions: In patients with severe GHD and patients with multiple pituitary hormone deficiencies, MRI is more likely to be abnormal, and bone age is much delayed in patients with history of prenatal disorders. Keywords: bone age; growth hormone deficiency (GHD); magnetic resonance imaging (MRI); short stature. DOI 10.1515/jpem-2013-0294 Received July 13, 2013; accepted July 14, 2014; previously published online August 13, 2014
*Corresponding author: Sohrab Afshari Mirak, Bahrami Pediatrics Hospital, Kiani St, Damavand St, Imam Hossein Sq, Tehran 1641744991, Iran, Phone: +982173013000, Fax: +982177551584, E-mail: [email protected] Fariba Naderi: Department of Endocrinology, Bahrami Pediatrics Hospital, Tehran University of Medical Sciences, Tehran, Iran Samira Rajabi Eslami, Mohammad Khak, Jalaladin Amiri and Bahram Beyrami: Bahrami Pediatrics Research Center, Tehran University of Medical Sciences, Tehran, Iran Babak Shekarchi: Department of Radiology, Bahrami Pediatrics Hospital, Tehran, Iran Masoud Poureisa: Tabriz Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
Short stature is a major cause of admission to pediatrics endocrine clinics with several etiologies such as malabsorption, chronic kidney disease, endocrinopathies, rickets, and chromosomal disorders (1). Growth hormone deficiency (GHD) is a disorder resulting from lack of growth hormone (GH), a polypeptide secreted from the anterior pituitary gland. This hormone not only affects the body growth, but also participates in regulation of the metabolism of lipids, proteins, and carbohydrates (1). Hence, GHD may cause several problems for the patients such as bone, muscular and cardiovascular disorders, and psychological consequences (2–6) which are treatable in most cases, if diagnosed properly. The diagnostic test of choice for GHD is the GH stimulating test with l-3,4-dihydroxyphenylalanine (l-DOPA), clonidine, arginine, and insulin. If the hormone level is
Fariba Naderi, Samira Rajabi Eslami, Sohrab Afshari Mirak*, Mohammad Khak, Jalaladin Amiri, Bahram Beyrami, Babak Shekarchi and Masoud Poureisa
Effect of growth hormone deficiency on brain MRI findings among children with growth restrictions Introduction
Abstract Objectives: Growth hormone deficiency (GHD) is a major problem among children with short stature. In this study, the role of brain magnetic resonance imaging (MRI) in defining the underlying defects among short children with GHD is evaluated. Methods: In a cross-sectional study, data of 158 children were evaluated. Growth hormone (GH) levels were measured using stimulating tests and brain MRI with gadolinium contrast was applied, as well. Results: Some 25.3% of patients had GHD with a mean age of 8.01 ± 3.40 years. MRI results showed 35 as normal, four with pituitary hypoplasia, and one with microadenoma. The MRI results were significantly associated with GH levels and presence of other endocrine disorders. There was a significant association between prenatal disorders and patients’ bone age delay. Conclusions: In patients with severe GHD and patients with multiple pituitary hormone deficiencies, MRI is more likely to be abnormal, and bone age is much delayed in patients with history of prenatal disorders. Keywords: bone age; growth hormone deficiency (GHD); magnetic resonance imaging (MRI); short stature. DOI 10.1515/jpem-2013-0294 Received July 13, 2013; accepted July 14, 2014; previously published online August 13, 2014
*Corresponding author: Sohrab Afshari Mirak, Bahrami Pediatrics Hospital, Kiani St, Damavand St, Imam Hossein Sq, Tehran 1641744991, Iran, Phone: +982173013000, Fax: +982177551584, E-mail: [email protected] Fariba Naderi: Department of Endocrinology, Bahrami Pediatrics Hospital, Tehran University of Medical Sciences, Tehran, Iran Samira Rajabi Eslami, Mohammad Khak, Jalaladin Amiri and Bahram Beyrami: Bahrami Pediatrics Research Center, Tehran University of Medical Sciences, Tehran, Iran Babak Shekarchi: Department of Radiology, Bahrami Pediatrics Hospital, Tehran, Iran Masoud Poureisa: Tabriz Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
Short stature is a major cause of admission to pediatrics endocrine clinics with several etiologies such as malabsorption, chronic kidney disease, endocrinopathies, rickets, and chromosomal disorders (1). Growth hormone deficiency (GHD) is a disorder resulting from lack of growth hormone (GH), a polypeptide secreted from the anterior pituitary gland. This hormone not only affects the body growth, but also participates in regulation of the metabolism of lipids, proteins, and carbohydrates (1). Hence, GHD may cause several problems for the patients such as bone, muscular and cardiovascular disorders, and psychological consequences (2–6) which are treatable in most cases, if diagnosed properly. The diagnostic test of choice for GHD is the GH stimulating test with l-3,4-dihydroxyphenylalanine (l-DOPA), clonidine, arginine, and insulin. If the hormone level is
