This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Chen, S. Articles by Czernichow, P. Search for Related Content PubMed PubMed Citation Articles by Chen, S. Articles by Czernichow, P. Pubmed/NCBI databases OMIM Compound via MeSH Substance via MeSH Medline Plus Health Information MRI Scans

Growth Hormone Deficiency with Ectopic Neurohypophysis: Anatomical Variations and Relationship between the Visibility of the Pituitary Stalk Asserted by Magnetic Resonance Imaging and Anterior Pituitary Function

Pediatric Endocrinology-Diabetology, and Radiology (C.G., M.H.) Units, Hôpital Robert Debré, 75019 Paris, France

Address all correspondence and requests for reprints to: Juliane Leger, M.D., Pediatric Endocrinology and Diabetes Unit, Hôpital Robert Debré, 48 boulevard Sérurier, 75019 Paris, France.

In GH-deficient children showing ectopic posterior pituitary hyperintense signal (EPP), the anatomical details of the pituitary-hypothalamic region and the relationship between the visibility of the pituitary stalk and anterior pituitary function were studied by magnetic resonance imaging (MRI). The absence or presence of the pituitary stalk was recorded by MRI before and after the injection of gadolinium in 25 children with GH deficiency and EPP at the age of 8.7 ± 5.0 yr (16 males and 9 females). Patients were classified into 2 groups according to the presence (group 1; n = 14), or the absence (group 2; n = 11) of pituitary stalk visibility after gadolinium injection. Most patients in group 1 (12 of 14) demonstrated isolated GH deficiency, whereas all but 1 patient in group 2 showed multiple anterior pituitary hormone deficiency. The prevalence of a normally sized adenohypophysis was higher in group 1 than in group 2 (50% vs. 9%; P < 0.05). Although the EPP was found at the median eminence in all group 2 patients, it was visualized in group 1 at different levels of the pituitary stalk in 60% of cases (8 of 14; at the proximal end of the pituitary stalk, n = 4; in the middle of the pituitary stalk, n = 2; at the distal end of the pituitary stalk, n = 2). This demonstrates that the ectopic posterior pituitary migration abnormality may be complete or partial.

In conclusion, although the pathogenesis of GH deficiency with EPP remains unclear, these results suggest that in cases of GH deficiency associated with ectopic posterior pituitary hyperintense signal, patients with no visible pituitary stalk on MRI after gadolinium injection present a more severe form of the disease in childhood associated with multiple anterior pituitary hormone deficiency, whereas visibility of the pituitary stalk is related to isolated GH deficiency. Nevertheless, careful follow-up of these latter patients is necessary, as the natural history of the disease is not established until adulthood.

This article has been cited by other articles:

				F. Berkowitz, P.J. Lee, A.L. Martin, and M.M. Martin Enlargement of the Proximal Pituitary Stalk Associated with Spontaneous Recovery from Multiple Pituitary Hormone Deficiencies AJNR Am. J. Neuroradiol., September 1, 2008; 29(8): 1601 - 1602. [Abstract] [Full Text] [PDF]

				D. A. van Tijn, J. J. M. de Vijlder, and T. Vulsma Role of the Thyrotropin-Releasing Hormone Stimulation Test in Diagnosis of Congenital Central Hypothyroidism in Infants J. Clin. Endocrinol. Metab., February 1, 2008; 93(2): 410 - 419. [Abstract] [Full Text] [PDF]

				G. Gelwane, C. Garel, D. Chevenne, P. Armoogum, D. Simon, P. Czernichow, and J. Leger Subnormal Serum Insulin-Like Growth Factor-I Levels in Young Adults with Childhood-Onset Nonacquired Growth Hormone (GH) Deficiency Who Recover Normal GH Secretion May Indicate Less Severe but Persistent Pituitary Failure J. Clin. Endocrinol. Metab., October 1, 2007; 92(10): 3788 - 3795. [Abstract] [Full Text] [PDF]

				A. S. A. van der Linden and H. W. van Es Case 112: Pituitary Stalk Transection Syndrome with Ectopic Posterior Pituitary Gland Radiology, May 1, 2007; 243(2): 594 - 597. [Full Text] [PDF]

				A. Ladjouze, S. Soskin, C. Garel, M. Jullien, C. Naud-Saudreau, G. Pinto, P. Czernichow, and J. Leger GH deficiency with central precocious puberty: a new rare disorder associated with a developmental defect of the hypothalamic-pituitary area Eur. J. Endocrinol., April 1, 2007; 156(4): 463 - 469. [Abstract] [Full Text] [PDF]

				D. A. van Tijn, J. J. M. de Vijlder, B. Verbeeten Jr., P. H. Verkerk, and T. Vulsma Neonatal Detection of Congenital Hypothyroidism of Central Origin J. Clin. Endocrinol. Metab., June 1, 2005; 90(6): 3350 - 3359. [Abstract] [Full Text] [PDF]

				J. Leger, S. Danner, D. Simon, C. Garel, and P. Czernichow Do All Patients with Childhood-Onset Growth Hormone Deficiency (GHD) and Ectopic Neurohypophysis Have Persistent GHD in Adulthood? J. Clin. Endocrinol. Metab., February 1, 2005; 90(2): 650 - 656. [Abstract] [Full Text] [PDF]

				M. G. F. Osorio, S. Marui, A. A. L. Jorge, A. C. Latronico, L. S. S. Lo, C. C. Leite, V. Estefan, B. B. Mendonca, and I. J. P. Arnhold Pituitary Magnetic Resonance Imaging and Function in Patients with Growth Hormone Deficiency with and without Mutations in GHRH-R, GH-1, or PROP-1 Genes J. Clin. Endocrinol. Metab., November 1, 2002; 87(11): 5076 - 5084. [Abstract] [Full Text] [PDF]

				L. A. Mitchell, P. Q. Thomas, M. R. Zacharin, and I. E. Scheffer Ectopic Posterior Pituitary Lobe and Periventricular Heterotopia: Cerebral Malformations with the Same Underlying Mechanism? AJNR Am. J. Neuroradiol., October 1, 2002; 23(9): 1475 - 1481. [Abstract] [Full Text] [PDF]

				K. W. Sloop, E. C. Walvoord, A. D. Showalter, O. H. Pescovitz, and S. J. Rhodes Molecular Analysis of LHX3 and PROP-1 in Pituitary Hormone Deficiency Patients with Posterior Pituitary Ectopia J. Clin. Endocrinol. Metab., August 1, 2000; 85(8): 2701 - 2708. [Abstract] [Full Text]