title: Associations with multiple pituitary hormone deficiency in patients with an ectopic posterior pituitary gland.
abstract: BACKGROUND
  The presence of an ectopic posterior pituitary gland (EPP) on magnetic resonance imaging (MRI) is associated with hypopituitarism with one or more hormone deficiencies. We aimed to identify risk factors for having multiple pituitary hormone deficiency (MPHD) compared to isolated growth hormone deficiency (IGHD) in patients with an EPP.
  
  
  METHODS
  In 67 patients (45 male) with an EPP on MRI, the site (hypothalamic vs. stalk) and surface area (SA) [ x (maximum diameter/2) x (maximum height/2), mm(2)] of the EPP were recorded and compared in patients with IGHD and MPHD in relation to clinical characteristics.
  
  
  RESULTS
  In MPHD (n = 32) compared to IGHD (n = 35) patients: age of presentation was younger (1.4 [0.1-10.7]vs. 4.0 [0.1-11.3] years, P = 0.005), major incidents during pregnancy were increased (47%vs. 20%, P = 0.02) as were admissions to a neonatal intensive care unit (NICU) (60%vs. 26%, P = 0.04), whilst EPP SA was lower (12.3 [2.4-34.6]vs. 25.7 [6.9-48.2] mm(2), P < 0.001). In patients with a hypothalamic (n = 56) compared to a stalk sited EPP (n = 11): prevalence of MPHD was greater (55%vs. 9%,P = 0.05) and EPP surface area was smaller (17.3 [2.4-48.2]vs. 25.3 [11.8-38.5] mm(2), P < 0.001). In regression analysis, after adjusting for age, presence of MPHD was associated with: major incidents during pregnancy (RR 6.8 [95%CI 1.2-37.7]), hypothalamic EPP site (RR 10.9 [1.0-123.9]) and small EPP SA (RR 2.5 [1.0-5.0] for tertiles of SA).
  
  
  CONCLUSIONS
  In patients with an EPP, adverse antenatal events, size (small) and position (hypothalamic) of the posterior pituitary gland on MRI were associated with MPHD. These findings suggest that adverse factors during pregnancy may be important for the development of an EPP.
authors.affiliation: Departments of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK. peter.clayton@manchester.ac.uk
authors.forename: P G
authors.initials: PG
authors.lastname: Murray
authors.forename: C
authors.initials: C
authors.lastname: Hague
authors.forename: O
authors.initials: O
authors.lastname: Fafoula
authors.forename: L
authors.initials: L
authors.lastname: Patel
authors.forename: A L
authors.initials: AL
authors.lastname: Raabe
authors.forename: C
authors.initials: C
authors.lastname: Cusick
authors.forename: C M
authors.initials: CM
authors.lastname: Hall
authors.forename: N B
authors.initials: NB
authors.lastname: Wright
authors.forename: R
authors.initials: R
authors.lastname: Amin
authors.forename: P E
authors.initials: PE
authors.lastname: Clayton
mesh_terms: D002648:Child; D002675:Child, Preschool; D002828:Choristoma / Q000150:complications / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007018:Hypopituitarism / Q000150:complications / Q000453:epidemiology*; D007027:Hypothalamic Diseases / Q000150:complications / Q000453:epidemiology*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010904:Pituitary Gland, Posterior; D010907:Pituitary Hormones / Q000172:deficiency*; D011247:Pregnancy; D015995:Prevalence
chemical_list: D010907:Pituitary Hormones