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Intracranial Pathologies and Endocrine Results: Single Pediatric Endocrinology Center Experience

Year 2022, Volume: 32 Issue: 6, 714 - 718, 31.12.2022
https://doi.org/10.54005/geneltip.1200537

Abstract

ABSTRACT
Intracranial pathologies can affect pituitary hormone levels whether they are primarily related to the pituitary gland or not. In pituitary hormone deficiencies, the size and location of the pituitary gland may be normal, as well as one or more hormone effects may be observed after hypoplasia, partial empty sella, ectopic neurohypophysis, Rathke's cleft cyst, adenomas and other pituitary masses or surgeries. In early puberty, the pituitary dimensions are usually increased, rarely hypoplasia and rathke cleft cyst are seen as MRI findings. Non-pituitary pathologies cause especially early puberty, single or multiple pituitary hormone deficiency.
In this study, we aimed to categorize the patients with pituitary/cranial lesions and hormonal pathology and to determine their frequency and distribution in the single pediatric endocrinology clinic for ten years.
The data of 485 patients, 186 (38.3%) male, were retrospectively analyzed. Their mean age was 9.3 ± 3.2 years. The incidental pituitary lesion was found in 28 (5.77%) of all cases. There was no hormonal influence in 20 (71.4%) of them. In most of the 454 cases with hormonal disorders, MRI (Magnetic Resonance Imaging) findings were normal in most of the 454 cases with hormonal disorders (71.8%). The most common hormonal pathologies were precocious puberty and isolated Growth Hormone deficiency, 57.9% and 26.4% respectively. Non-pituitary lesions (n=23, 5%) were most frequently accompanied by early puberty (39.1%).
The hypothalamus-pituitary axis may be affected by primary lesions in its own region, or it may be seen as a result of other cranial pathologies. Cranial evaluation is also important in addition to pituitary imaging in pituitary hormone disorders.

References

  • 1. Sizonenko PC, Clayton PE, Cohen P, Hintz RL, Tanaka T, Laron Z. Diagnosis and management of growth hormone deficiency in childhood and adolescence. Part 1: diagnosis of growth hormone deficiency. Growth Horm IGF Res. 2001;11(3):137-165.
  • 2. Latronico AC, Brito VN, Carel JC. Causes, diagnosis, and treatment of central precocious puberty. Lancet Diabetes Endocrinol. 2016;4(3):265-274.
  • 3. Baldeweg SE, Ball S, Brooke A, et al. SOCIETY FOR ENDOCRINOLOGY CLINICAL GUIDANCE: Inpatient management of cranial diabetes insipidus. Endocr Connect. 2018;7(7):G8-G11.
  • 4. Zhu J, Feldman HA, Eugster EA, et al. PRACTICE VARIATION IN THE MANAGEMENT OF GIRLS AND BOYS WITH DELAYED PUBERTY. Endocr Pract. 2020;26(3):267-284.
  • 5. Bosch I Ara L, Katugampola H, Dattani MT. Congenital Hypopituitarism During the Neonatal Period: Epidemiology, Pathogenesis, Therapeutic Options, and Outcome. Front Pediatr. 2021;8:600962. Published 2021 Feb 2.
  • 6. Higham CE, Johannsson G, Shalet SM. Hypopituitarism. Lancet. 2016;388(10058):2403-2415.
  • 7. Melmed S, Casanueva FF, Hoffman AR, et al. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(2):273-288.
  • 8. Hage M, Kamenický P, Chanson P. Growth Hormone Response to Oral Glucose Load: From Normal to Pathological Conditions. Neuroendocrinology. 2019;108(3):244-55.
  • 9. Sari S, Sari E, Akgun V, et al. Measures of pituitary gland and stalk: from neonate to adolescence. J Pediatr Endocrinol Metab. 2014;27(11-12):1071-1076.
  • 10. Bellotto E, Monasta L, Pellegrin MC, et al. Pattern and Features of Pediatric Endocrinology Referrals: A Retrospective Study in a Single Tertiary Center in Italy. Front Pediatr. 2020;8:580588. Published 2020 Oct 2.
  • 11. Baldo F, Marin M, Murru FM, Barbi E, Tornese G. Dealing With Brain MRI Findings in Pediatric Patients With Endocrinological Conditions: Less Is More?. Front Endocrinol (Lausanne). 2022;12:780763. Published 2022 Jan 12.
  • 12. Souteiro P, Maia R, Santos-Silva R, et al. Pituitary incidentalomas in paediatric age are different from those described in adulthood. Pituitary. 2019;22(2):124-128.
  • 13. Shareef M, Nasrallah MP, AlArab N, Atweh LA, Zadeh C, Hourani R. Pituitary incidentalomas in paediatric population: Incidence and characteristics. Clin Endocrinol (Oxf). 2021;94(2):269276
  • 14. Raper DM, Besser M. Clinical features, management and recurrence of symptomatic Rathke's cleft cyst. J Clin Neurosci. 2009;16(3):385-389.
  • 15. Oh YJ, Park HK, Yang S, Song JH, Hwang IT. Clinical and radiological findings of incidental Rathke's cleft cysts in children and adolescents. Ann Pediatr Endocrinol Metab. 2014;19(1):20-26.
  • 16. Debnath J, Ravikumar R, Sharma V, et al. 'Empty sella' on routine MRI studies: An incidental finding or otherwise?. Med J Armed Forces India. 2016;72(1):33-37.
  • 17. Aguirre RS, Eugster EA. Central precocious puberty: From genetics to treatment. Best Pract Res Clin Endocrinol Metab. 2018;32(4):343-354.
  • 18. Maghnie M, Lindberg A, Koltowska-Häggström M, Ranke MB. Magnetic resonance imaging of CNS in 15,043 children with GH deficiency in KIGS (Pfizer International Growth Database). Eur J Endocrinol. 2013;168(2):211-217.
  • 19. Choi KH, Chung SJ, Kang MJ, et al. Boys with precocious or early puberty: incidence of pathological brain magnetic resonance imaging findings and factors related to newly developed brain lesions. Ann Pediatr Endocrinol Metab. 2013;18(4):183-190.
  • 20. De Sanctis V, Corrias A, Rizzo V, et al. Etiology of central precocious puberty in males: the results of the Italian Study Group for Physiopathology of Puberty. J Pediatr Endocrinol Metab. 2000;13 Suppl 1:687-193.
  • 21. Pedicelli S, Alessio P, Scirè G, Cappa M, Cianfarani S. Routine screening by brain magnetic resonance imaging is not indicated in every girl with onset of puberty between the ages of 6 and 8 years. J Clin Endocrinol Metab. 2014;99(12):4455-4461.
  • 22. Mogensen SS, Aksglaede L, Mouritsen A, et al. Pathological and incidental findings on brain MRI in a single-center study of 229 consecutive girls with early or precocious puberty. PLoS One. 2012;7(1):e29829. 23. Rosenfield RL, Cooke DW, Radovick S, Puberty in the Female and Its Disorders. In Sperling MA (ed). Sperling Pediatric Endocrinology 5th edition, Elsevier, Philedelphia 2020,Pages 528-626.
  • 24. Palmert MR, Chang YM, Dunkel L, Puberty and Its Disorders in the Male. In Sperling MA (ed). Sperling Pediatric Endocrinology 5th edition, Elsevier, Philedelphia 2020,Pages 661-694
  • 25. Cantas-Orsdemir S, Garb JL, Allen HF. Prevalence of cranial MRI findings in girls with central precocious puberty: a systematic review and meta-analysis. J Pediatr Endocrinol Metab. 2018;31(7):701-710. 26. Kaplowitz P, Bloch C; Section on Endocrinology, American Academy of Pediatrics. Evaluation and Referral of Children With Signs of Early Puberty. Pediatrics. 2016;137(1):10.1542
  • 27. Jussila MP, Olsén P, Salokorpi N, Suo-Palosaari M. Follow-up of pineal cysts in children: is it necessary?. Neuroradiology. 2017;59(12):1265-1273.
  • 28. Filippo G, Gaudino R, Calcaterra V, Villani A, Bozzola E, Bozzola M. Incidental pineal gland cyst in girls with early onset of puberty. Ital J Pediatr. 2022;48(1):44. Published 2022 Mar 21.
  • 29. Chiu CF, Wang CJ, Chen YP, Lo FS. Pathological and Incidental Findings in 403 Taiwanese Girls With Central Precocious Puberty at Initial Diagnosis. Front Endocrinol (Lausanne). 2020;11:256.
  • 30. Schmitt J, Thornton P, Shah AN, et al. Brain MRIs may be of low value in most children diagnosed with isolated growth hormone deficiency. J Pediatr Endocrinol Metab. 2021;34(3):333-340.
  • 31. Yesquen P, Clemente M, Campos A, Mogas E., et al. Brain Magnetic Resonance Imaging in Children with Isolated Growth Hormone Deficiency and Idiopathic Short Stature Diagnoses ESPE Abstracts (2019) 92 P2-164

İNTRAKRANİYAL PATOLOJİLER VE ENDOKRİN SONUÇLARI: TEK ÇOCUK ENDOKRİNOLOJİ MERKEZİ TECRÜBESİ

Year 2022, Volume: 32 Issue: 6, 714 - 718, 31.12.2022
https://doi.org/10.54005/geneltip.1200537

Abstract

İntrakranial patolojiler hipofiz beziyle primer bağlantılı olsun veya olmasın hipofizer hormon düzeylerini etkileyebilirler. Hipofizer hormon eksikliklerinde hipofiz bezi boyutları ve yerleşimi normal olabildiği gibi hipoplazi, parsiyel empty sella, ektopik nörohipofiz, rathke kleft kisti, adenomlar ve hipofiz yerleşimli diğer kitleler veya cerrahilerinden sonra da bir veya birçok hormon etkilenmesi görülebilir. Erken pubertede hipofiz boyutları genellikle artar, nadiren hipoplazi ve rathke yarık kisti Manyetik Rezonans Görüntüleme (MRG) bulguları olarak görülür. Hipofiz dışı patolojiler özellikle erken ergenliğe, tek veya çoklu hipofiz hormon eksikliğine neden olur.
Bu çalışmada, tek pediatrik endokrinoloji kliniğinde on yıl boyunca hipofiz/kraniyal lezyonları ve hormonal patolojisi olan hastaların kategorize edilmesi, sıklık ve dağılımlarını belirlenmesi amaçlanmıştır.
186'sı (%38,3) erkek 485 hastanın verileri geriye dönük olarak incelendi. Ortalama yaşları 9.3 ± 3.2 yıldı. Tüm olguların 28'inde (%5.77) tesadüfi hipofiz lezyonu saptandı. Bunların 20'sinde (%71,4) hormonal etki yoktu. Hormonal bozukluğu olan 454 olgunun çoğunda MRG bulguları normaldi (%71.8). En sık görülen hormonal patolojiler sırasıyla %57.9 ve %26.4 ile erken ergenlik ve izole büyüme hormonu eksikliği idi. Hipofiz dışı lezyonlara (n=23, %5) en sık erken ergenlik (%39.1) eşlik ediyordu.
Hipotalamus-hipofiz ekseni kendi bölgesindeki primer lezyonlardan etkilenebileceği gibi diğer kraniyal patolojilerin sonucu olarak da görülebilir. Hipofiz hormon bozukluklarında hipofiz MRG’yle birlikte kraniyal değerlendirme de yapılmalıdır.

References

  • 1. Sizonenko PC, Clayton PE, Cohen P, Hintz RL, Tanaka T, Laron Z. Diagnosis and management of growth hormone deficiency in childhood and adolescence. Part 1: diagnosis of growth hormone deficiency. Growth Horm IGF Res. 2001;11(3):137-165.
  • 2. Latronico AC, Brito VN, Carel JC. Causes, diagnosis, and treatment of central precocious puberty. Lancet Diabetes Endocrinol. 2016;4(3):265-274.
  • 3. Baldeweg SE, Ball S, Brooke A, et al. SOCIETY FOR ENDOCRINOLOGY CLINICAL GUIDANCE: Inpatient management of cranial diabetes insipidus. Endocr Connect. 2018;7(7):G8-G11.
  • 4. Zhu J, Feldman HA, Eugster EA, et al. PRACTICE VARIATION IN THE MANAGEMENT OF GIRLS AND BOYS WITH DELAYED PUBERTY. Endocr Pract. 2020;26(3):267-284.
  • 5. Bosch I Ara L, Katugampola H, Dattani MT. Congenital Hypopituitarism During the Neonatal Period: Epidemiology, Pathogenesis, Therapeutic Options, and Outcome. Front Pediatr. 2021;8:600962. Published 2021 Feb 2.
  • 6. Higham CE, Johannsson G, Shalet SM. Hypopituitarism. Lancet. 2016;388(10058):2403-2415.
  • 7. Melmed S, Casanueva FF, Hoffman AR, et al. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(2):273-288.
  • 8. Hage M, Kamenický P, Chanson P. Growth Hormone Response to Oral Glucose Load: From Normal to Pathological Conditions. Neuroendocrinology. 2019;108(3):244-55.
  • 9. Sari S, Sari E, Akgun V, et al. Measures of pituitary gland and stalk: from neonate to adolescence. J Pediatr Endocrinol Metab. 2014;27(11-12):1071-1076.
  • 10. Bellotto E, Monasta L, Pellegrin MC, et al. Pattern and Features of Pediatric Endocrinology Referrals: A Retrospective Study in a Single Tertiary Center in Italy. Front Pediatr. 2020;8:580588. Published 2020 Oct 2.
  • 11. Baldo F, Marin M, Murru FM, Barbi E, Tornese G. Dealing With Brain MRI Findings in Pediatric Patients With Endocrinological Conditions: Less Is More?. Front Endocrinol (Lausanne). 2022;12:780763. Published 2022 Jan 12.
  • 12. Souteiro P, Maia R, Santos-Silva R, et al. Pituitary incidentalomas in paediatric age are different from those described in adulthood. Pituitary. 2019;22(2):124-128.
  • 13. Shareef M, Nasrallah MP, AlArab N, Atweh LA, Zadeh C, Hourani R. Pituitary incidentalomas in paediatric population: Incidence and characteristics. Clin Endocrinol (Oxf). 2021;94(2):269276
  • 14. Raper DM, Besser M. Clinical features, management and recurrence of symptomatic Rathke's cleft cyst. J Clin Neurosci. 2009;16(3):385-389.
  • 15. Oh YJ, Park HK, Yang S, Song JH, Hwang IT. Clinical and radiological findings of incidental Rathke's cleft cysts in children and adolescents. Ann Pediatr Endocrinol Metab. 2014;19(1):20-26.
  • 16. Debnath J, Ravikumar R, Sharma V, et al. 'Empty sella' on routine MRI studies: An incidental finding or otherwise?. Med J Armed Forces India. 2016;72(1):33-37.
  • 17. Aguirre RS, Eugster EA. Central precocious puberty: From genetics to treatment. Best Pract Res Clin Endocrinol Metab. 2018;32(4):343-354.
  • 18. Maghnie M, Lindberg A, Koltowska-Häggström M, Ranke MB. Magnetic resonance imaging of CNS in 15,043 children with GH deficiency in KIGS (Pfizer International Growth Database). Eur J Endocrinol. 2013;168(2):211-217.
  • 19. Choi KH, Chung SJ, Kang MJ, et al. Boys with precocious or early puberty: incidence of pathological brain magnetic resonance imaging findings and factors related to newly developed brain lesions. Ann Pediatr Endocrinol Metab. 2013;18(4):183-190.
  • 20. De Sanctis V, Corrias A, Rizzo V, et al. Etiology of central precocious puberty in males: the results of the Italian Study Group for Physiopathology of Puberty. J Pediatr Endocrinol Metab. 2000;13 Suppl 1:687-193.
  • 21. Pedicelli S, Alessio P, Scirè G, Cappa M, Cianfarani S. Routine screening by brain magnetic resonance imaging is not indicated in every girl with onset of puberty between the ages of 6 and 8 years. J Clin Endocrinol Metab. 2014;99(12):4455-4461.
  • 22. Mogensen SS, Aksglaede L, Mouritsen A, et al. Pathological and incidental findings on brain MRI in a single-center study of 229 consecutive girls with early or precocious puberty. PLoS One. 2012;7(1):e29829. 23. Rosenfield RL, Cooke DW, Radovick S, Puberty in the Female and Its Disorders. In Sperling MA (ed). Sperling Pediatric Endocrinology 5th edition, Elsevier, Philedelphia 2020,Pages 528-626.
  • 24. Palmert MR, Chang YM, Dunkel L, Puberty and Its Disorders in the Male. In Sperling MA (ed). Sperling Pediatric Endocrinology 5th edition, Elsevier, Philedelphia 2020,Pages 661-694
  • 25. Cantas-Orsdemir S, Garb JL, Allen HF. Prevalence of cranial MRI findings in girls with central precocious puberty: a systematic review and meta-analysis. J Pediatr Endocrinol Metab. 2018;31(7):701-710. 26. Kaplowitz P, Bloch C; Section on Endocrinology, American Academy of Pediatrics. Evaluation and Referral of Children With Signs of Early Puberty. Pediatrics. 2016;137(1):10.1542
  • 27. Jussila MP, Olsén P, Salokorpi N, Suo-Palosaari M. Follow-up of pineal cysts in children: is it necessary?. Neuroradiology. 2017;59(12):1265-1273.
  • 28. Filippo G, Gaudino R, Calcaterra V, Villani A, Bozzola E, Bozzola M. Incidental pineal gland cyst in girls with early onset of puberty. Ital J Pediatr. 2022;48(1):44. Published 2022 Mar 21.
  • 29. Chiu CF, Wang CJ, Chen YP, Lo FS. Pathological and Incidental Findings in 403 Taiwanese Girls With Central Precocious Puberty at Initial Diagnosis. Front Endocrinol (Lausanne). 2020;11:256.
  • 30. Schmitt J, Thornton P, Shah AN, et al. Brain MRIs may be of low value in most children diagnosed with isolated growth hormone deficiency. J Pediatr Endocrinol Metab. 2021;34(3):333-340.
  • 31. Yesquen P, Clemente M, Campos A, Mogas E., et al. Brain Magnetic Resonance Imaging in Children with Isolated Growth Hormone Deficiency and Idiopathic Short Stature Diagnoses ESPE Abstracts (2019) 92 P2-164
There are 29 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Article
Authors

Ülkü Gül Şiraz 0000-0001-7708-3498

Early Pub Date December 31, 2022
Publication Date December 31, 2022
Submission Date November 7, 2022
Published in Issue Year 2022 Volume: 32 Issue: 6

Cite

Vancouver Gül Şiraz Ü. Intracranial Pathologies and Endocrine Results: Single Pediatric Endocrinology Center Experience. Genel Tıp Derg. 2022;32(6):714-8.