磁共振成像在儿童生长激素缺乏症评估中的必要性:来自大型学术中心的经验教训

IF 1.6 4区 医学 Q4 CELL BIOLOGY Growth Hormone & Igf Research Pub Date : 2021-10-01 DOI:10.1016/j.ghir.2021.101427
Leena Mamilly , Amy L. Pyle-Eilola , Monika Chaudhari , Rohan K. Henry
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引用次数: 1

摘要

背景:目前的指南不加区分地推荐儿童生长激素缺乏症(GHD)的垂体磁共振成像(MRI)。异常MRI(主要是肿瘤)与生长激素峰值水平之间的关系尚不清楚。方法回顾性收集3 ~ 16岁儿童GHD的垂体MRI结果,根据刺激激素峰值水平分为3组;≤5,5 - 7.4和7.5-10 ng/mL, A组,B组和;C分别。比较两组患者的临床和MRI表现。结果共纳入399例患儿。A组MRI异常发生率为36.9%,B组为16.7%,C组为17.0%,p值均为0.0002。多发性垂体激素缺乏症(MPHD)患儿的异常发生率高于单纯GHD患儿。孤立性GHD患儿更有可能出现异常MRI和GH峰值;5 ng/mL与5 - 7.4水平的人相比;7.5 -10 ng / mL。A组4例患儿发生颅咽管瘤。将GH峰值水平与异常MRI结果进行ROC分析,IGHD和MPHD的曲线下面积(AUC)分别为0.614和0.728。结论虽然3个研究组均有MRI异常,但以GH水平的MRI异常居多;5ng /mL和MPHD儿童。为避免遗漏肿瘤,对GHD患儿和GH峰值水平(≤5ng /mL)进行影像学检查的重要性再怎么强调也不为过。
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The necessity of magnetic resonance imaging in the evaluation of pediatric growth hormone deficiency: Lessons from a large academic center

Background

Current guidelines indiscriminately recommend magnetic resonance imaging (MRI) of the pituitary gland in pediatric growth hormone deficiency (GHD). The relationship between abnormal MRI, most importantly a tumor, and peak GH levels is not well known.

Methods

In this retrospective chart review, pituitary MRI results of children, ages of 3–16 years with GHD were collected and divided into 3 groups according to peak stimulated GH levels; ≤5, 5–7.4 and 7.5–10 ng/mL, Groups A, B & C respectively. Clinical and MRI findings were compared between the groups.

Results

A total of 399 children were included. Abnormal MRI was found in 36.9% of group A subjects, compared to group B (16.7%) and group C (17.0%), both p values =0.0002. Children with multiple pituitary hormonal deficiencies (MPHD) had a higher rate of abnormalities than those with isolated GHD. Children with isolated GHD were more likely to have abnormal MRI with peak GH level < 5 ng/mL compared to those with levels, 5–7.4 & 7.5–10 ng/mL. 4 children in group A had a craniopharyngioma. ROC analysis comparing peak GH levels with abnormal MRI findings showed an area under the curve (AUC) of 0.614 and 0.728 for IGHD and MPHD, respectively.

Conclusion

Although abnormal MRI was found in all 3 study groups, it was more likely at GH level < 5 ng/mL and in children with MPHD. To avoid missing a tumor, the importance of imaging in children with GHD and peak GH levels <5 ng/mL cannot be overemphasized.

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来源期刊
Growth Hormone & Igf Research
Growth Hormone & Igf Research 医学-内分泌学与代谢
CiteScore
3.30
自引率
0.00%
发文量
38
审稿时长
57 days
期刊介绍: Growth Hormone & IGF Research is a forum for research on the regulation of growth and metabolism in humans, animals, tissues and cells. It publishes articles on all aspects of growth-promoting and growth-inhibiting hormones and factors, with particular emphasis on insulin-like growth factors (IGFs) and growth hormone. This reflects the increasing importance of growth hormone and IGFs in clinical medicine and in the treatment of diseases.
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