title: Brain Magnetic Resonance Imaging as First-Line Investigation for Growth Hormone Deficiency Diagnosis in Early Childhood.
abstract: OBJECTIVE
  The diagnosis of growth hormone (GH) deficiency (GHD) in infancy and early childhood is not straightforward. GH stimulation tests are unsafe and unreliable in infants, and normative data are lacking. This study aims to investigate whether brain magnetic resonance imaging (MRI) may replace GH stimulation tests in the diagnosis of GHD in children younger than 4 years.
  
  
  METHODS
  We examined a retrospective cohort, with longitudinal follow-up, of 68 children consecutively diagnosed with GHD before the age of 4 years. The prevalence of hypothalamic-pituitary (HP) alterations at MRI and the associations with age and either isolated GHD (IGHD) or multiple pituitary hormone deficiency (MPHD) were assessed.
  
  
  RESULTS
  The prevalences of IGHD and MPHD were 54.4 and 45.6%, respectively. In the first group, brain MRI showed abnormalities in 83.8%: isolated pituitary hypoplasia in 48.7% and complex defects in 35.1%. In patients with MPHD, MRI showed complex alterations in 100%. All children younger than 24 months showed HP MRI abnormalities, regardless of the diagnosis. Complex defects were found in 94% of patients younger than 12 months and in 75% of patients between 13 and 24 months.
  
  
  CONCLUSIONS
  Our data suggest that brain MRI may represent the first-line investigation for diagnosing GHD in infancy and early childhood.
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Valentina
authors.initials: V
authors.lastname: Pampanini
authors.forename: Stefania
authors.initials: S
authors.lastname: Pedicelli
authors.forename: Jessica
authors.initials: J
authors.lastname: Gubinelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Scirè
authors.forename: Marco
authors.initials: M
authors.lastname: Cappa
authors.forename: Brunetto
authors.initials: B
authors.lastname: Boscherini
authors.forename: Stefano
authors.initials: S
authors.lastname: Cianfarani
mesh_terms: D000367:Age Factors; D001827:Body Height; D001921:Brain / Q000473:pathology*; D002675:Child, Preschool; D015331:Cohort Studies; D004393:Dwarfism, Pituitary / Q000175:diagnosis / Q000473:pathology; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D019382:Human Growth Hormone / Q000009:adverse effects / Q000172:deficiency* / Q000494:pharmacology; D006801:Humans; D007018:Hypopituitarism / Q000175:diagnosis; D007223:Infant; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D010907:Pituitary Hormones / Q000097:blood / Q000172:deficiency; D012189:Retrospective Studies
chemical_list: D010907:Pituitary Hormones; D019382:Human Growth Hormone