help button home button Endocrine Society JCEM JCEM Call for Nominations for EIC
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2004-1558
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
90/6/3274    most recent
Author Manuscript (PDF)
Right arrow Submit a related Letter to the Editor
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Copyright Permission
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Fink, A. M.
Right arrow Articles by Cameron, F. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Fink, A. M.
Right arrow Articles by Cameron, F. J.
Related Collections
Right arrow Neuroendocrinology and Pituitary
Right arrow Pediatric Endocrinology
The Journal of Clinical Endocrinology & Metabolism Vol. 90, No. 6 3274-3278
Copyright © 2005 by The Endocrine Society

Age-Related Pituitary Volumes in Prepubertal Children with Normal Endocrine Function: Volumetric Magnetic Resonance Data

A. M. Fink, S. Vidmar, S. Kumbla, C. C. Pedreira, S. Kanumakala, C. Williams, J. B. Carlin and F. J. Cameron

Departments of Medical Imaging (A.M.F., S.Ku., C.W.) and Endocrinology and Diabetes (C.C.P., S.Ka., F.J.C.), Royal Children’s Hospital, Parkville, Victoria 3052, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute (S.V., J.B.C.), Parkville, Victoria 3052, Australia; and Department of Radiology (A.M.F.) and Pediatrics (C.C.P., S.K., F.J.C., S.V., J.B.C.), University of Melbourne, Parkville, Victoria 3052, Australia

Address all correspondence and requests for reprints to: Dr. A. Michelle Fink, Department of Medical Imaging, Royal Children’s Hospital, Flemington Road, Parkville, Victoria 3052, Australia. E-mail: michelle.fink{at}wch.org.au.


   Abstract
Top
 Abstract
Introduction
 Subjects and Methods
 Results
 Discussion
 References
 
Background: Evaluation of the size of the pituitary gland on magnetic resonance imaging (MRI) may be difficult, considering the wide variation in normal gland morphology. Given the paucity of age-related biometric data, our purpose was to obtain standard normal reference values for pituitary volumes in prepubertal children using three-dimensional MRI data.

Methods: Children under the age of 10 yr undergoing brain MRI for seizures or idiopathic developmental delay and who had no endocrine abnormality were recruited prospectively over 2 yr. All MRI studies included a three-dimensional sequence. Only subjects with normal studies were included. One hundred thirty-nine children were eligible (mean age, 5.2 yr). Direct pituitary volumes were measured from contiguous 1-mm thick reconstructed coronal and sagittal images. Estimated pituitary volumes were calculated using pituitary height, width, and length.

Results: Volumes obtained from reconstructions in either plane were essentially identical. There was a linear increase in log-transformed pituitary volume with age, but relatively weak correlations with height or body mass index. There was no gender difference and only weak correlations between pituitary height and pituitary volume and between estimated pituitary volume calculation and measured pituitary volume. We provide age-related reference ranges for pituitary volumes in graphical and tabular forms.


   Introduction
Top
 Abstract
 Introduction
Subjects and Methods
 Results
 Discussion
 References
 
THE USE OF magnetic resonance imaging (MRI) for the evaluation of neurological and endocrine disorders in children has increased dramatically over the last 10 yr. This has coincided with a rapid evolution of MRI technology, with fast sequences and increasing image resolution allowing accurate visualization of even small structures. Three-dimensional (3D) data acquisition now allows the direct evaluation rather than estimated calculations of volumes. Despite this, there is an absence of useful reference data for the normal range of pituitary volumes in children (1, 2).

MRI of the pituitary is advocated as part of the baseline investigations to be performed on children with poor growth or suspected endocrinopathy (1, 2, 3, 4, 5, 6, 7, 8, 9). Notwithstanding its frequent clinical use, recognition of abnormalities in pituitary size can be difficult, and radiological reports of pituitary gland size are frequently based upon subjective judgment. The size and shape of the normal pituitary gland vary considerably and are also affected by age, sex, and hormonal environment (10, 11, 12, 13, 14, 15, 16, 17, 18). This is also true throughout childhood, with the most dramatic changes seen in the neonatal period and in puberty (18, 19, 20, 21, 22, 23). The variation in shape of the pituitary between individuals means that any assessment of its size will be subject to a high degree of imprecision unless a true volume is measured.

Most reports to date on the size or volume of the normal pituitary gland on MRI come from data acquired in two dimensions, and most are in the adult population. They are mainly based on measurements in a single plane (usually gland height) (11, 12, 13, 14, 15, 16, 17, 18) or on rough approximations of volumes calculated from two-dimensional (2D) data (10). In only one study, which included 17 normal adolescent controls, were volumes directly measured from 3D datasets (24).

There are only two publications of which we are aware that describe the size of the normal whole pituitary gland in children relative to age. One is a study of the height of the pituitary gland as a function of age (20), and this has frequently been quoted as a standard reference (2, 4, 7, 17, 25, 26, 27). The other is the only study in children to use 3D magnetic resonance volumetry (23). This study includes prepubertal and postpubertal children and is limited to a Japanese population.

The aim of our study was to establish a normal reference range for pituitary volumes according to age in prepubertal children based on true volumetric measurements in an ethnically diverse population.


   Subjects and Methods
Top
 Abstract
 Introduction
 Subjects and Methods
Results
 Discussion
 References
 
Subjects

After receiving ethics approval from the ethics in human research committee of Royal Children’s Hospital, we recruited 254 children up to the age of 10 yr. The study period extended from July 2001 to September 2003. The children included in the study were to have MRI of the brain as part of the investigation of possible seizures or idiopathic developmental delay. The study population reflected the wide ethnic mix of the catchment area of our institution, which is predominantly European and southeast Asian. Written informed consent was obtained from all parents/guardians before the child’s participation.

Exclusion criteria

Any patient with a history or clinical evidence of endocrine abnormality, genetic syndrome, preterm delivery at less than 35 wk gestation, birth asphyxia, hospitalization for head injury, craniospinal irradiation, or abnormal MRI of the brain was excluded from the study. Any patient who was peri- or postpubertal on examination was also excluded from the study. After application of these exclusion criteria, 143 children were considered for inclusion.

Clinical assessment

All subjects were clinically assessed by one of two endocrinologists (C.C.P. or S.K.) before the MRI. Information regarding signs and symptoms of endocrine disorders, use of endocrine therapies, genital abnormalities, and genetic syndromes was recorded. Weight was assessed by digital scale, and height was determined by Harpenden stadiometer. Body mass index (BMI) was calculated as the ratio of weight to height2 (kg/m2). Patients with extreme values of height were excluded, because height was considered the most appropriate auxological indicator of subclinical endocrinopathy. In addition to this, all patients studied were clinically euthyroid and had a normal (prepubertal) genital appearance.

MRI evaluation

MRI examinations were performed using a GE 1.5 T Echospeed LX system. Thin section volumetric studies were obtained using T1-weighted sagittal 3D fast spoiled gradient echo (SPGR) data acquisition according to our protocol for the investigation of seizures and congenital brain abnormalities. The following parameters were used: minimum echo time and repetition time, inversion time of 350 msec for children over 2 yr increasing up to 850 msec for infants under 6 months of age, 320 x 192 matrix (zero filled to 512 x 512), 25° flip angle, 8.33-Hz band width, 1- to 1.4-mm slice thickness (interpolated to 0.5–0.7 mm), and 21- to 23-cm of field of view. For infants under 6 months of age, the parameters were as follows: 3D T1-weighted SPGR with minimum full echo time, 35-msec repetition time, 45° flip angle, 8.93-Hz bandwidth, 20- to 26-cm field of view, 0.8- to 1.2-mm slice thickness, and 256 x 192 matrix. This conventional spoiled gradient echo (SPGR) sequence was used because it was determined in clinical studies that the inherent tissue contrast of the fast SPGR was not appropriate for gray/white matter differentiation in this younger age group.

To obtain the pituitary volumes, additionally targeted sagittal and coronal reformats with 1-mm contiguous slices were obtained from the 3D dataset. The cross-sectional areas of the pituitary gland were measured manually using a surface area mark-up tool on the contiguous 1-mm sections in both sagittal and coronal planes. The volume (in cubic millimeters) was obtained by adding the areas (in square millimeters) for each plane. In addition, the maximum height and length of the gland were measured from the midsagittal image, and the maximum width of the gland was measured from the coronal images. The hyperintense posterior pituitary was included in all measurements of the entire gland.

Indirect volume calculations were performed using the formula most commonly used by previous researchers: V = (length x height x width)/2 (2, 8, 10, 28, 29). This formula was originally derived from the formula of an ellipsoid [V = (4{pi}/3) x (length x height x width)/2] to estimate the volume of the sella turcica on plain radiographs in 1960 (30).

All volume measurements were performed by one radiologist (S.K.), who was blinded to demographic data of the subjects. Volume measurements for 21 children were repeated after an interval of a minimum of 3 months to assess intraobserver reliability.

Statistical analysis

Height and BMI were converted to z-scores, adjusting for age and sex using the 1990 British growth reference (31). The concordance correlation coefficient (CCC) was calculated to assess the agreement between pituitary volume measured on coronal and sagittal planes (32). Spearman’s correlation was used to measure the association between pituitary volume and pituitary height, width, and thickness. Reference values with 95% ranges were obtained by regression analysis, using fractional polynomials where necessary to handle nonlinearity (33, 34). Because the distribution of pituitary volumes was skewed, analysis was performed on the logarithms, with resulting summaries given as geometric means for the volume. Stata software were used for all statistical analyses (release 8.0, Stata Corp., College Station, TX).


   Results
Top
 Abstract
 Introduction
 Subjects and Methods
 Results
Discussion
 References
 
Subjects

Of the 143 children thought to be eligible for inclusion, four children with height z-score absolute values greater than 2.2 were excluded; in the remaining sample, 5.0% (seven of 139) had heights outside the normal 95% range. The remaining total of 139 children up to the age of 10 yr, with 82 males and 57 females, were included in the study. Table 1Go summarizes the clinical characteristics of the children.


View this table:
[in this window]
[in a new window]
  		TABLE 1. Clinical characteristics of the subjects included in the study

 
Pituitary morphology

We observed extremely wide variation in the morphology of the pituitary gland on high resolution MRI regardless of subject age. No two pituitaries were identical in shape or distribution of the isointense anterior gland and the hyperintense posterior gland. They varied in their relative antero-posterior length and relative height, whereas the shape varied from crescent-like to hemispherical and near-spherical. In some, the anterior height was greater; in others, the posterior height was greater; and some were dumbbell-shaped. The posterior pituitary bright spot could be elongated or flattened and extended variably in the anterior direction, often beneath the anterior portion of the gland (Fig. 1Go).



View larger version (67K):
[in this window]
[in a new window]
  		FIG. 1. Range of pituitary morphology encountered. Midsagittal (top) and midcoronal (bottom) images in seven patients (A–G), with pituitary shape varying from crescentic to globular.

 
Pituitary volume data analysis

Intraobserver reliability was high in the 21 repeated volume measurements, with a CCC of 0.986 [95% confidence interval (CI), 0.967–0.994].

There was very strong agreement between the volumes measured from the coronal and sagittal reconstructions (CCC, 0.986; 95% CI, 0.981–0.990; Fig. 2Go). Because there was no substantial difference between the volumes obtained from the coronal and sagittal reconstructions, the coronal value was used for subsequent analysis.



View larger version (13K):
[in this window]
[in a new window]
  		FIG. 2. Concordance of volumes of the whole pituitary gland obtained from measurements from coronal vs. sagittal MRI reconstructions (the dashed line represents perfect concordance).

 
There was a gradual linear increase in log pituitary volume over the first 10 yr of life (Fig. 3Go). The estimated geometric mean and 95% reference interval for pituitary gland volume by year of age are presented in Table 2Go. When separate regression models were fitted for males and females, the estimated geometric mean pituitary volumes were almost identical (Fig. 4Go). Weak correlations were found between pituitary volume and height, and BMI z-score (Spearman correlations, 0.20, and 0.17, respectively). There was also only a weak correlation between pituitary volume and pituitary height, with a Spearman correlation coefficient of 0.35 (95% CI, 0.20–0.49; Fig. 5Go).



View larger version (15K):
[in this window]
[in a new window]
  		FIG. 3. Pituitary volume plotted against age, with the estimated geometric mean and 95% reference interval (based on linear regression fit to log-transformed volume).

 

View this table:
[in this window]
[in a new window]
  		TABLE 2. Geometric mean and reference intervals for pituitary gland volume by year of age (derived from mean regression model for log volume)

 


View larger version (15K):
[in this window]
[in a new window]
  		FIG. 4. Pituitary volumes plotted against age, separately by gender, with estimated geometric means for girls and boys.

 


View larger version (18K):
[in this window]
[in a new window]
  		FIG. 5. Scatterplot of pituitary volume vs. pituitary height. Pituitary heights were recorded to the nearest integer and have been "jittered" for display purposes.

 
The calculated volume using the formula derived from that for the volume of an ellipsoid showed only modest agreement with measured pituitary volume (CCC, 0.46; CI, 0.37–0.54).


   Discussion
Top
 Abstract
 Introduction
 Subjects and Methods
 Results
 Discussion
References
 
There is a recognized need for more normative data on pituitary size in the pediatric population (1, 2). In this study we reported MRI data on measured pituitary volumes in an ethnically diverse group of prepubertal children with morphologically normal brains and no clinical evidence of endocrinopathy. For ease of reference, we have tabulated these data as mean values and both 90% and 95% reference ranges. Volumetric data acquisition with MRI means that true volumes can be measured from the imaging obtained. In our experience, the manual technique for volume measurement is not difficult, usually taking about 5 min/study. Our results demonstrate that our method of volume measurement is robust, providing a true volume that is independent of the plane (sagittal or coronal) in which the data are reconstructed.

Prepubertal pituitary volumes were found to increase with age and appeared to be independent of gender. Independent of age, there was no correlation found between either height or BMI and pituitary volume.

Direct 3D assessment of pituitary volume represents a significant advance over methods used in the past with 2D datasets. In these studies, pituitary size was estimated using a single linear measurement (usually pituitary height) (11, 12, 13, 14, 16, 17, 18, 20) or by volumes crudely calculated using formulas adapted from the formula for the volume of an ellipsoid and originally used to estimate the volume of the sella turcica on plain films (10, 30). The vast variation in the shape of the normal pituitary gland, which we confirmed, means that neither linear measurements nor calculated volumes can give a true estimate of pituitary size. This is substantiated by the weak correlation we found between pituitary height and measured pituitary volume and between calculated volume and measured pituitary volume.

To date, the only other published normal data on whole pituitary volumes measured directly from volumetric data are the study by Takano et al. (23). This study included 199 Japanese children, 121 of whom were under the age of 10 yr. The mean prepubertal values and SDs given were reported in relatively broad age groupings of 0–1, 1–4, and 5–9 yr. There appears to be a slight discrepancy compared with our results, in that the measured pituitary volume values reported by Takano et al. are slightly higher, particularly in the 5–9 yr age group. We are unable to explain the variability between these two studies other than to note that there were several differences between the two studies, namely, the different ethnic compositions of the study populations and the grouped age intervals. Data for anterior pituitary volumes have also recently been published (35) in a European cohort. This cross-sectional study by Marziali et al. (35) included 95 children under 10 yr of age, again plotted according to age. The volumes reported by Marziali et al. (35) are only slightly greater than the pituitary volumes described in this study, notwithstanding the fact that only anterior pituitary volumes were measured. The significance of this is unknown given the limited data presented by Marziali et al. (35) about the number of patients in each yearly age grouping and the variability noted in their volume by age (i.e. pituitary volume was reported to decrease between ages 2–3 and 7–8 yr). The difference may simply reflect wide CIs due to low patient numbers when substratified at yearly age intervals.

When using normal reference values, it is important to ensure that study data acquisition has been performed in a similar fashion as reference data. A recent publication (2) calculated pituitary volumes from 2D images using the Di Chiro-derived formula and compared these crude estimates with the 3D true volumetric normative data reported by Takano et al. (23). We advocate using only volumetric MRI techniques and direct volume measurements when evaluating pituitary gland size, because these give the most reliable results.

In summary, we have presented normative, directly measured, 3D volumetric data for pituitary size in prepubertal children. Pituitary gland shape in this age group is highly variable; hence, we found that direct measures of pituitary volume do not correlate with either one-dimensional estimates (height) or 2D, indirectly calculated volumes. Our approach to direct measurement of pituitary volume appears to be robust, with assessment using either sagittal or coronal data reconstructions giving practically identical results. We recommend that with the advent of improved MRI technology and 3D data acquisition, indirect estimates of pituitary size and volume should be replaced by direct volumetric analysis.


   Acknowledgments
 
We thank Gabrielle Davie, for initial statistical analyses, and Michael Keane, for technical MRI advice.


   Footnotes
 
S.Ka. was the Novo Nordisk United Kingdom Pediatric Endocrine Fellow for 2001. C.P. was the recipient of a research grant from Eli Lilly, Australia.

First Published Online March 22, 2005

Abbreviations: BMI, Body mass index; CCC, concordance correlation coefficient; CI, confidence interval; 2D, two-dimensional; 3D, three-dimensional; MRI, magnetic resonance imaging; SPGR, spoiled gradient echo.

Received August 13, 2004.

Accepted March 15, 2005.


   References
Top
 Abstract
 Introduction
 Subjects and Methods
 Results
 Discussion
 References
 

  1. GH Research Society 2000 Consensus guidelines for the diagnosis and treatment of growth hormone (GH) deficiency in childhood and adolescence: summary statement of the GH Research Society. J Clin Endocrinol Metab 85:3990–3993[Free Full Text]
  2. Alba M, Hall CM, Whatmore AJ, Clayton PE, Price DA, Salvatori R 2004 Variability in anterior pituitary size within members of a family with GH deficiency due to a new splice mutation in the GHRH receptor gene. Clin Endocrinol (Oxf) 60:470–475[CrossRef][Medline]
  3. Sharafuddin MJA, Luisiri A, Garibaldi LR, Fulk DL, Klein JB, Gillespie KN, Graviss ER 1994 MR imaging diagnosis of central precocious puberty: importance of changes in the shape and size of the pituitary gland. AJR. Am J Roentgenol 162:1167–1173[Abstract/Free Full Text]
  4. Bozzola M, Adamsbaum C, Biscaldi I, Zecca M, Cisternino M, Genovese E, Richard I, Kalifa G, Chaussain JL 1996 Role of magnetic resonance imaging in the diagnosis and prognosis of growth hormone deficiency. Clin Endocrinol (Oxf) 45:21–26[CrossRef][Medline]
  5. Kornreich L, Horev G, Lazar L, Schwarz M, Sulkes J, Pertzelan A 1998 MR findings in growth hormone deficiency: correlation with severity of hypopituitarism. AJNR Am J Neuroradiol 19:1495–1499[Abstract]
  6. Bozzola M, Mengarda F, Sartirana P, Tato L, Chaussain JL 2000 Long-term follow-up evaluation of magnetic resonance imaging in the prognosis of permanent GH deficiency. Eur J Endocrinol 143:493–496[Abstract]
  7. Tillmann V, Tang VWM, Price DA, Hughes DG, Wright NB, Clayton PE 2000 Magnetic resonance imaging of the hypothalamic-pituitary axis in the diagnosis of growth hormone deficiency. J Pediatr Endocrinol Metab 13:1577–1583[Medline]
  8. Arslanoglu I, Kutlu H, Isgüven P, Tokus F, Isik K 2001 Diagnostic value of pituitary MRI in differentiation of children with normal growth hormone secretion, isolated growth hormone deficiency and multiple pituitary hormone deficiency. J Pediatr Endocrinol Metab 14:517–523[Medline]
  9. Kemp SF, Alter CA, Dana K, Baptista J, Blethen SL 2002 Use of magnetic resonance imaging in short stature: data from National Cooperative Growth Study (NCGS) Substudy 8. J Pediatr Endocrinol Metab 15(Suppl 2):675–679
  10. Lurie SN, Doraiswamy PM, Husain MM, Boyko OB, Ellinwood Jr EH, Figiel GS, Krishnan KRR 1990 In vivo assessment of pituitary gland volume with magnetic resonance imaging: the effect of age. J Clin Endocrinol Metab 71:505–508[Abstract]
  11. Suzuki M, Takashima T, Kayoda M, Konishi H, Kameyama T, Yoshikawa J, Gabata T, Arai K, Tamura S, Yamamoto T, Kawahara K 1990 Height of normal pituitary gland on MR imaging: age and sex differentiation. J Comput Assit Tomogr 14:36–39[Medline]
  12. Elster AD, Chen MYM, Williams III DW, Key LL 1990 Pituitary gland: MR imaging of physiologic hypertrophy in adolescence. Radiology 174:681–685[Abstract/Free Full Text]
  13. Elster AD, Sanders TG, Vines FS, Chen MYM 1991 Size and shape of the pituitary gland during pregnancy and post partum: measurement with MR imaging. Radiology 181:531–535[Abstract/Free Full Text]
  14. Doraiswamy PM, Potts JM, Axelson DA, Husain MM, Lurie SN, Na C, Escalona PR, Mcdonald WM, Figiel GS, Ellinwood Jr EH, Boyko OB, Krishnan KRR 1992 MR Assessment of pituitary gland morphology in healthy volunteers: age and gender-related differences. AJNR Am J Neuroradiol 13:1295–1299[Abstract]
  15. Elster AD 1993 Modern imaging of the pituitary. Radiology 87:1–14
  16. Tsunoda A, Okuda O, Sato K 1997 MR height of the pituitary gland as a function of age and sex: especially physiological hypertrophy in adolescence and in climacterium. AJNR Am J Neuroradiol 18:551–554[Abstract]
  17. Denk CC, Onderoglu S, Ilgi S, Gurcan F 1999 Height of normal pituitary gland on MRI: differences between age groups and sexes. Okajimas Folia Anat Jpn 76:81–88[Medline]
  18. Kato K, Saeki N, Yamaura A 2002 Morphological changes on MR imaging of the normal pituitary gland related to age and sex: main emphasis on pubescent females. J Clin Neurosci 9:53–56[CrossRef][Medline]
  19. Cox TD, Elster AD 1991 Normal pituitary gland: changes in shape, size and signal intensity during the 1st year of life at MR imaging. Radiology 179::721–724
  20. Argyropoulou M, Perignon F, Brunelle F, Brauner R, Rappaport R 1991 Height of normal pituitary gland as a function of age evaluated by magnetic resonance imaging in children. Pediatr Radiol 21:247–249[CrossRef][Medline]
  21. Tien RD, Kucharczyk J, Bessette J, Middleton M 1992 MR imaging of the pituitary gland in infants and children: changes in size, shape, and MR signal with growth and development. AJR Am J Roentgenol 158:1151–1154[Abstract/Free Full Text]
  22. Dietrich RB, Lis LE, Greensite FS, Pitt D 1995 Normal MR appearance of the pituitary gland in the first 2 years of life. AJNR Am J Neuroradiol 16:1413–1419[Abstract]
  23. Takano K, Utsunomiya H, Ono H, Ohfu M, Okazaki M 1999 Normal development of the pituitary gland: assessment with three-dimensional MR volumetry. AJNR Am J Neuroradiol 20:312–315[Abstract/Free Full Text]
  24. MacMaster FP, Kusumakar V 2004 MRI study of the pituitary gland in adolescent depression. J Psych Res 38:231–236[CrossRef]
  25. Arends NJ, v d Lip W, Robben SG, Hokken-Koelega AC 2002 MRI findings of the pituitary gland in short children born small for gestational age (SGA) in comparison with growth hormone-deficient (GHD) children and children with normal stature. Clin Endocrinol (Oxf) 57:719–724[CrossRef][Medline]
  26. Binder G, Nagel BHP, Ranke MB, Mullis PE 2002 Isolated GH deficiency (IGHD) type II: imaging of the pituitary gland by magnetic resonance reveals characteristic differences in comparison with severe IGHD of unknown origin. Eur J Endocrinol 147:755–760[Abstract]
  27. Kornreich L, Horev G, Schwarz M, Karmazyn B, Laron Z 2003 Pituitary size in patients with Laron syndrome (primary GH insensitivity). Eur J Endocrinol 148:339–341[Abstract]
  28. Maghnie M, Triulzi F, larizza D, Preti P, Priora C, Scotti G, Severi F 1991 Hypothalamic-pituitary dysfunction in growth hormone-deficient patients with pituitary abnormalities. J Clin Endocrinol Metab 73:79–83[Abstract]
  29. Löppönen T, Pääkkö E, Laittinen J 1997 Saukkonen AL, Serlo W, Tapanainen P, Ruokonen A, Pirttiniemi P, Poikela A, Knip M. Pituitary size and function in children and adolescents with shunted hydrocephalus. Clin Endocrinol (Oxf) 46:691–699[CrossRef][Medline]
  30. Di Chiro G, Nelson KB 1962 The volume of the sella turcica. Am J Roentgenol Radium Ther Nucl Med 87:989–1008[Medline]
  31. Cole TJ, Freeman JV, Preece MA 1998 British 1990 growth reference centiles for weight, height, body mass index and head circumference fitted by maximum penalized likelihood. Stat Med 17:407–429[CrossRef][Medline]
  32. Lin L 1989 A concordance correlation coefficient to evaluate reproducibility. Biometrics 45:255–268[CrossRef][Medline]
  33. Royston P 1991 Constructing time-specific reference ranges. Stat Med 10:675–690[Medline]
  34. Royston P, Wright EM 1998 A method for estimating age-specific reference intervals (’normal ranges’) based on fractional polynomials and exponential transformation. J R Stat Soc A 161:79–101
  35. Marziali S, Gaudiello F, Bozzao A, Scirè G, Ferone E, Colangelo V, Simonetti A, Boscherini B, Floris R, Simonetti G 2004 Evaluation of anterior pituitary gland volume in childhood using three-dimensional MRI. Pediatr Radiol 34:547–551[Medline]



This article has been cited by other articles:


Home page
 J. Clin. Endocrinol. Metab.Home page
R. W. Pfaeffle, J. J. Savage, C. S. Hunter, C. Palme, M. Ahlmann, P. Kumar, J. Bellone, E. Schoenau, E. Korsch, J. H. Bramswig, et al.
Four Novel Mutations of the LHX3 Gene Cause Combined Pituitary Hormone Deficiencies with or without Limited Neck Rotation
J. Clin. Endocrinol. Metab., May 1, 2007; 92(5): 1909 - 1919.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
A. P. S. Bhangoo, C. S. Hunter, J. J. Savage, H. Anhalt, S. Pavlakis, E. C. Walvoord, S. Ten, and S. J. Rhodes
A Novel LHX3 Mutation Presenting as Combined Pituitary Hormonal Deficiency
J. Clin. Endocrinol. Metab., March 1, 2006; 91(3): 747 - 753.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
90/6/3274    most recent
Author Manuscript (PDF)
Right arrow Submit a related Letter to the Editor
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Copyright Permission
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Fink, A. M.
Right arrow Articles by Cameron, F. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Fink, A. M.
Right arrow Articles by Cameron, F. J.
Related Collections
Right arrow Neuroendocrinology and Pituitary
Right arrow Pediatric Endocrinology

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Endocrinology Endocrine Reviews J. Clin. End. & Metab.
Molecular Endocrinology Recent Prog. Horm. Res. All Endocrine Journals