title: Facial and pituitary morphology are related in Dutch patients with GH deficiency.
abstract: OBJECTIVE
  Classical GH deficiency (GHD) is associated with typical phenotypic features. We have analysed standardized photographs of 137 Caucasian patients with GHD, in order to examine the relations between auxological, biochemical, pituitary and facial morphometric features.
  
  
  METHODS
  We analysed pictures of 137 patients: 73 (55 Males/18 Females) with Isolated GHD and 64 (48 M/16 F) with multiple pituitary hormone deficiency (MPHD). Of each patient, standardized frontal and lateral digital pictures were taken and analysed using Adobe Photoshop 5.0.
  
  
  RESULTS
  Canthal index (CI), the relative distance between the eyes, was related to pituitary morphology. Patients with an ectopic posterior pituitary (EPP) had significantly higher CI values than patients without EPP. We found CI > 39 to be a good cut-off value to select children with highest probability of having EPP. The combination of CI > 39 with the presence of hormonal deficiencies additional to GHD strongly predicted EPP: 93% of the patients with a CI > 39 and additional hormonal deficiencies had EPP, in contrast to 77% of the patients with additional hormonal deficiencies but a CI < 39, and 29% of the patients with none of these criteria (P = 0.0001).
  
  
  CONCLUSIONS
  CI, measured on digital pictures, is associated with ectopia of the posterior pituitary and this might be caused by an altered midline development, affecting both the pituitary and the facial structures of GHD patients.
authors.affiliation: Department of Pediatrics, Division of Endocrinology Sophia Children's Hospital, Rotterdam, The Netherlands. l.degraaff@erasmusmc.nl
authors.forename: L C G
authors.initials: LC
authors.lastname: de Graaff
authors.forename: J
authors.initials: J
authors.lastname: Baan
authors.forename: L C P
authors.initials: LC
authors.lastname: Govaerts
authors.forename: A C S
authors.initials: AC
authors.lastname: Hokken-Koelega
mesh_terms: D000293:Adolescent; D000328:Adult; D001837:Body Weights and Measures / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D005145:Face / Q000473:pathology*; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology / Q000473:pathology*; D019382:Human Growth Hormone / Q000172:deficiency*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D010902:Pituitary Gland / Q000473:pathology*; D055815:Young Adult
chemical_list: D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I