title: Reliability of magnetic resonance imaging for the detection of hypopituitarism in children with optic nerve hypoplasia.
abstract: OBJECTIVE
  It is essential to identify hypopituitarism in children with optic nerve hypoplasia (ONH) because they are at risk for developmental delay, seizures, or death. The purpose of this study is to determine the reliability of neurohypophyseal abnormalities on magnetic resonance imaging (MRI) for the detection of hypopituitarism in children with ONH.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  One hundred one children with clinical ONH who underwent MRI of the brain and orbits and a detailed pediatric endocrinologic evaluation.
  
  
  METHODS
  Magnetic resonance imaging studies were performed on 1.5-Tesla scanners. The imaging protocol included sagittal T1-weighted images, axial fast fluid-attenuated inversion-recovery/T2-weighted images, and diffusion-weighted images of the brain. Orbital imaging included fat-saturated axial and coronal images and high-resolution axial T2-weighted images. The MRI studies were reviewed by 2 pediatric neuroradiologists for optic nerve hypoplasia, absent or ectopic posterior pituitary, absent pituitary infundibulum, absent septum pellucidum, migration anomalies, and hemispheric injury. Medical records were reviewed for clinical examination findings and endocrinologic status. All patients underwent a clinical evaluation by a pediatric endocrinologist and a standardized panel of serologic testing that included serum insulin-like growth factor-1, insulin-like growth factor binding protein-3, prolactin, cortisol, adrenocorticotropic hormone, thyroid-stimulating hormone, and free thyroxine levels. Radiologists were masked to patients' endocrinologic status and funduscopic findings.
  
  
  METHODS
  Sensitivity and specificity of MRI findings for the detection of hypopituitarism.
  
  
  RESULTS
  Neurohypophyseal abnormalities, including absent pituitary infundibulum, ectopic posterior pituitary bright spot, and absent posterior pituitary bright spot, occurred in 33 children. Magnetic resonance imaging disclosed neurohypophyseal abnormalities in 27 of the 28 children with hypopituitarism (sensitivity, 96%). A normal neurohypophysis occurred in 67 of 73 children with normal endocrinologic function (specificity, 92%).
  
  
  CONCLUSIONS
  Neurohypophyseal abnormalities on MRI are sensitive and specific indicators of hypopituitarism in children with ONH.
authors: Department of Radiology, Arkansas Children's Hospital, University of Arkansas Medical Center, Little Rock, Arkansas; Department of Ophthalmology, University of Arkansas Medical Center, Arkansas Children's Hospital, Little Rock, Arkansas.
authors: Raghu H
authors: RH
authors: Ramakrishnaiah
authors: Department of Neuro-Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.
authors: Julie B
authors: JB
authors: Shelton
authors: Department of Radiology, Arkansas Children's Hospital, University of Arkansas Medical Center, Little Rock, Arkansas.
authors: Charles M
authors: CM
authors: Glasier
authors: Department of Ophthalmology, University of Arkansas Medical Center, Arkansas Children's Hospital, Little Rock, Arkansas. Electronic address: PhillipsPaulH@uams.edu.
authors: Paul H
authors: PH
authors: Phillips
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D002658:Developmental Disabilities / Q000175:diagnosis; D005124:Eye Abnormalities / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007018:Hypopituitarism / Q000175:diagnosis*; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009887:Ophthalmoscopy; D009900:Optic Nerve / Q000002:abnormalities*; D010902:Pituitary Gland / Q000002:abnormalities*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult