Arends N J T, V d Lip W, Robben S G F, Hokken-Koelega A C S
Division of Endocrinology, Department of Pediatrics, Sophia Children's Hospital/Erasmus University, Rotterdam, the Netherlands.
Clin Endocrinol (Oxf). 2002 Dec;57(6):719-24. doi: 10.1046/j.1365-2265.2002.01605.x.
Disturbances in the GH/IGF-I axis are reported in 25-60% of short children born small for gestational age (SGA). We hypothesized that these abnormalities might be related to abnormalities in the pituitary region. Therefore, the results of magnetic resonance imaging (MRI) of short SGA children were compared to MRI results of other groups of short children and to normal controls.
MRI was performed in four groups of short children: SGA children without GH deficiency (SGA group; n = 17), SGA children with isolated GH deficiency (SGA + IGHD group; n = 10), non-SGA children with isolated GH deficiency (IGHD group; n = 24) and non-SGA children with multiple pituitary hormone deficiencies (MPHD group; n = 15). MRI was also performed in children with normal stature (control group; n = 13). Pituitary height (PH) and thickness of the pituitary stalk (PS) were measured and their relationship with the maximum GH peak during a GH stimulation test, serum IGF-I and IGFBP-3 levels was evaluated.
Short SGA children either with or without IGHD did not show major anatomical abnormalities in the hypothalamic-pituitary region in contrast to 58% of the non-SGA IGHD children and 87% of the MPHD children who had anatomical abnormalities. PH in SGA children without GHD was normal whereas it was significantly lower in SGA children with IGHD. The lowest PHs were measured in non-SGA children with MPHD. A moderate decrease in PH was associated with significantly lower maximum serum GH peaks and lower serum IGF-I and IGFBP-3 levels.
Measuring PHs in children with less severe GHD, who underwent MRI as part of the diagnostic process, might support the diagnosis of GHD even in the absence of anatomical abnormalities. Our study demonstrates that there is no indication to perform MRI of the pituitary region in short children born SGA without GHD.
据报道，25% - 60%的小于胎龄儿（SGA）出生的矮小儿童存在生长激素（GH）/胰岛素样生长因子 - I（IGF - I）轴功能紊乱。我们推测这些异常可能与垂体区域的异常有关。因此，将SGA矮小儿童的磁共振成像（MRI）结果与其他矮小儿童组及正常对照组的MRI结果进行了比较。
对四组矮小儿童进行了MRI检查：无GH缺乏的SGA儿童（SGA组；n = 17）、孤立性GH缺乏的SGA儿童（SGA + IGHD组；n = 10）、孤立性GH缺乏的非SGA儿童（IGHD组；n = 24）和多种垂体激素缺乏的非SGA儿童（MPHD组；n = 15）。还对身材正常的儿童进行了MRI检查（对照组；n = 13）。测量了垂体高度（PH）和垂体柄厚度（PS），并评估了它们与GH刺激试验期间最大GH峰值、血清IGF - I和IGFBP - 3水平的关系。
与58%有解剖学异常的非SGA IGHD儿童和87%有解剖学异常的MPHD儿童相比，有或无IGHD的SGA矮小儿童在下丘脑 - 垂体区域未显示出主要的解剖学异常。无GHD的SGA儿童的PH正常，而有IGHD的SGA儿童的PH显著较低。MPHD的非SGA儿童的PH测量值最低。PH适度降低与最大血清GH峰值显著降低以及血清IGF - I和IGFBP - 3水平降低有关。
对于诊断过程中接受MRI检查的轻度GHD儿童，测量PH可能有助于支持GHD的诊断，即使在没有解剖学异常的情况下。我们的研究表明，对于无GHD的SGA出生的矮小儿童，没有必要进行垂体区域的MRI检查。
