بررسی MRI مغزی در کودکان مبتلا به کمبود هورمون رشد مراجعه‌کننده به کلینیک غدد درون‌ریز ساری در سال‌های 96-1390

نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشیار، فوق تخصص غدد و متابولیسم کودکان،مرکز تحقیقات دیابت، دانشگاه علوم پزشکی مازندران، ساری، ایران.

2 دانشیار،گروه آمار زیستی، مرکز تحقیقات علوم بهداشتی، دانشکده بهداشت،دانشگاه علوم پزشکی مازندران،ساری،ایران

3 متخصص رادیولوژی،استادیار دانشگاه علوم پزشکی مازندران،ساری،ایران

4 پزشک عمومی،دانشگاه علوم پزشکی مازندران،ساری،ایران

5 کارشناس ارشد آمار زیستی،دانشگاه علوم پزشکی مازندران،ساری، ایران

چکیده

مقدمه: کمبود هورمون رشد ایدیوپاتیک ممکن است به صورت منفرد یا در ارتباط با کمبود سایر هورمون‌های هیپوفیزی باشد. استفاده از یافته‌های MRI مغزی برای افتراق میان دو گروه می‌تواند مفید باشد.
روش کار: این مطالعهی توصیفی گذشته‌نگر تمامی کوکان 16-2 ساله‌ای که بین سال‌های 1390-96 با شکایت کوتاهی قد به کلینیک باغبان ساری مراجعه کرده‌اند و تشخیص کمبود هورمون رشد منفرد یا کمبود متعدد هورمون‌های هیپوفیزی داده شد را مورد بررسی قرار می‌دهد.
نتایج: در این مطالعه 150 بیمار که 42 درصد آنها دختر بودند مورد ارزیابی قرار گرفتند. . میانگین سن بیماران  71/34±63/113 ماه بوده است. 7/68  درصد کمبود خفیف هورمون رشد و 3/31 درصدکمبود شدید هورمون رشد را نشان دادند . در مجموع 67/6 درصد کمبود متعدد هورمون‌های هیپوفیزی و  33/3 درصد کمبود ایزوله هورمون رشد داشتند. 33/79 درصد بیماران Brain MRI نرمال 67/20 درصد بیماران  MRI غیرطبیعی داشتند. یافته‌ها شامل هایپوپلازی و فقدان آدنوهیپوفیز 41 درصد، نوروهیپوفیز اکتوپیک56/2 درصد، میکروآدنوم هیپوفیز 82/12 درصد، Partial empty sella  64/25 درصد،  Complete empty sella  69/7 درصد و سایر یافته‌های گزارش شده 25/10 درصد بوده است.
نتیجه‌گیری: در این مطالعه آنومالی‌های هیپوفیز در MRI مغزی بیماران با کمبود متعدد هورمون‌های هیپوفیزی بیشتر از بیماران مبتلا به کمبود ایزوله هورمون رشد گزارش شده اما همچنان مشخص نشده است که یافته‌های پاتولوژیک در MRI به طور ثابتی با کمبود هورمون رشد دائمی در ارتباط باشد.

کلیدواژه‌ها

عنوان مقاله [English]

A study of brain MRI in children with growth hormone deficiency referred to the Sari Endocrine Clinic in 2011-2017

نویسندگان [English]

  • Daniel Zamanfar 1
  • Jamshid Yazdani Charati 2
  • Hadi majidi 3
  • Maryam Domehri 4
  • Sahar Fallah 5
1 Assistant Professor, Pediatric Endocrinologist, Diabetes Reaserch Center of Mazandaran, Mazandaran University of Medical Sciences, Sari, Iran.
2 Associate Professor, Department of Biostatistics, Health Sciences Research Center, School of Health, Mazandaran University of Medical Sciences, Sari, Iran
3 Radiologist, Assistant Professor, Mazandaran University of Medical Sciences, Sari, Iran
4 General Practitioner, Mazandaran University of Medical Sciences, Sari, Iran
5 Master of Biostatistics, Mazandaran University of Medical Sciences, Sari, Iran
چکیده [English]

Introduction: Idiopathic growth hormone deficiency may be isolated or associated with deficiency of other pituitary hormones. the use of brain MRI findings to differentiate between the two groups can be useful.
Methods: This descriptive study of the retrospective method, investigates all 2–6-year-old children, who referred to Sari Gardener Clinic between 1390 and 1396 with a short stature complaint, and diagnosed them with a single growth hormone deficiency or multiple hypophysis hormone deficiency. Patient file information that includes demographic information, history and clinical examination information, laboratory information, and paraclinical information were extracted.
Results: In this study, 150 patients, 63 of whom (42%) were girls, were evaluated. The mean age of the patients was 34.71 ± 113.63 months. 68.7% showed a slight deficiency of growth hormone and 31.3% showed a severe deficiency of growth hormone. A total of 6.67% had a significant deficiency of pituitary hormones and 93.33% had an isolated deficiency of growth hormone. 79.33% of patients had normal Brain MRI and 20.67% had abnormal MRI. The findings included hypoplasia and 41% loss of adenohypophysis, 2.56% ectopic neurohypophysis, 12.82% pituitary microadenoma, 25.64% partial empty sella, 7.69% Complete empty sella and other reported findings were 10.25%.
Conclusion: In this study Pituitary abnormalities in brain MRI have been reported in patients with multiple pituitary hormone deficiency more than in patients with isolated growth hormone deficiency, However, it has not been established that the pathological findings detected on MRI are consistently associated with permanent growth hormone deficiency.

کلیدواژه‌ها [English]

  • growth hormone deficiency
  • brain imaging
  • short stature
  • multiple pituitary hormone deficiency
  • child

مراجع

  1. Melmed S, Polonsky KS, Larsen PR, Kronenberg HM. Williams textbook of endocrinology: Elsevier
    Health Sciences; 2015. 988-92 p.
    2. Geisler A, Lass N, Reinsch N, Uysal Y, Singer V, Ravens-Sieberer U, et al. Quality of life in children
    and adolescents with growth hormone deficiency: association with growth hormone treatment. Hormone
    research in paediatrics. 2012;78(2):94-9.
    3. Kołtowska-Häggström M. Quality of life and growth hormone deficiency in adult patients in clinical
    evaluation and health economic assessment. Pediatric Endocrinology, Diabetes & Metabolism. 2009;15
    (3 .)
    4. Palmeiro CR, Anand R, Dardi IK, Balasubramaniyam N, Schwarcz MD, Weiss IA. Growth hormone and
    the cardiovascular system. Cardiology in review. 2012;20(4):197-207.
    5. Rogol AD. Clinical and humanistic aspects of growth hormone deficiency and growth-related disorders.
    Am J Manag Care. 2011;17(Suppl 18):S4-10.
    6. Xue P, Wang Y, Yang J, Li Y. Effects of growth hormone replacement therapy on bone mineral density
    in growth hormone deficient adults: a meta-analysis. International journal of endocrinology. 2013;2013.
    7. Kliegman R, Stanton B, Geme JS, N S. Nelson textbook of pediatrics2015. 2637-44 p.
    8. Deal C, Hasselmann C, Pfäffle RW, Zimmermann AG, Quigley CA, Child CJ, et al. Associations between
    pituitary imaging abnormalities and clinical and biochemical phenotypes in children with congenital
    growth hormone deficiency: data from an international observational study. Hormone research in
    paediatrics. 2013;79(5):283-92.
    9. Rona R, Tanner J. Aetiology of idiopathic growth hormone deficiency in England and Wales. Archives of
    disease in childhood. 1977;52(3):197-208.
    10. Vimpani G, Vimpani A, Lidgard G, Cameron E, Farquhar J. Prevalence of severe growth hormone
    deficiency. Br Med J. 19773.-427: (6084)2:
    11. Lindsay R, Feldkamp M, Harris D, Robertson J, Rallison M. Utah Growth Study: growth standards and
    the prevalence of growth hormone deficiency. The Journal of pediatrics. 1994;125(1):29-35.
    12. Phillips 3rd J, Cogan J. Genetic basis of endocrine disease. 6. Molecular basis of familial human growth
    hormone deficiency. The Journal of Clinical Endocrinology & Metabolism. 1994;78(1):11-6.
    13. Craft WH, Underwood LE, Van Wyk JJ. High incidence of perinatal insult in children with idiopathic
    hypopituitarism. The Journal of pediatrics. 1980;96(3):397-402.
    14. Luca FD, Bernasconi S, Blandino A, Cavallo L, Cisternino M. Auxological, clinical and
    neuroradiological findings in infants with early onset growth hormone deficiency. Acta Paediatrica. 1995
    ; 84 (5): 561 - .5
    15. Van den Broeck J, Vanderschueren-Lodeweyckx M, Malvaux P, Craen M, Van Vliet G, Dooms L, et al.
    Growth hormone deficiency: a hidden obstetrical trauma? European Journal of Obstetrics & Gynecology
    and Reproductive Biology. 1987;26(4):329 - .34
    16. Crowne EC, Shalet SM. Adult panhypopituitarism presenting as idiopathic growth hormone deficiency
    in childhood. Acta Pædiatrica. 1991;80(2):255-8.
  2. 17. Sperling MA. Sperling Pediatric Endocrinology E-Book. Elsevier Health Sciences; 2020; section 3;
    chapter11:319.
    18. Kornreich L, Horev G, Lazar L, Schwarz M, Sulkes J, Pertzelan A. MR findings in growth hormone
    deficiency: correlation with severity of hypopituitarism. American journal of neuroradiology.
    1998;19(8):1495-9.
    19. Bozzola M, Mengarda F, Sartirana P, Tato L, Chaussain J. Long-term follow-up evaluation of magnetic
    resonance imaging in the prognosis of permanent GH deficiency. European journal of endocrinology.
    2000;143(4):493-6.
    20. Hamilton J, Blaser S, Daneman D. MR imaging in idiopathic growth hormone deficiency. American journal
    of neuroradiology. 1998;19(9):1609-15.
    21. Naderi F, Eslami SR, Mirak SA, Khak M, Amiri J, Beyrami B, et al. Effect of growth hormone deficiency
    on brain MRI findings among children with growth restrictions. Journal of Pediatric Endocrinology and
    Metabolism. 2015;28(1-2):117-23.
    22. Marwaha R, Menon P, Jena A, Pant C, Sethi AK, Sapra M. Hypothalamo-pituitary axis by magnetic
    resonance imaging in isolated growth hormone deficiency patients born by normal delivery. The Journal
    of Clinical Endocrinology & Metabolism. 1992;74(3):654-9.
    23. Triulzi F, Scotti G, di Natale B, Pellini C, Lukezic M, Scognamiglio M, et al. Evidence of a congenital
    midline brain anomaly in pituitary dwarfs: a magnetic resonance imaging study in 101 patients. Pediatrics.
    1994;93(3):409-16.
    24. Adamsbaum C, Houang M, Andrè C, Richard I, Ginisty D, Chaussain J, et al. Imagerie par résonance
    magnétique des hypopituitarismes non tumoraux de l'enfant: étude de 52 cas. Revue d'imagerie médicale.
    1993;5(4):251-7.
    25. Argyropoulou M, Perignon F, Brauner R, Brunelle F. Magnetic resonance imaging in the diagnosis of
    growth hormone deficiency. The Journal of pediatrics. 1992;120(6):886-91.
    26. Cacciari E, Zucchini S, Ambrosetto P, Tani G, Carla G, Cicognani A, et al. Empty sella in children and
    adolescents with possible hypothalamic-pituitary disorders. The Journal of Clinical Endocrinology &
    Metabolism. 1994;78(3):767-71.
    27. Nagel B, Palmbach M, Petersen D, Ranke M. Magnetic resonance images of 91 children with different
    causes of short stature: pituitary size reflects growth hormone secretion. European journal of pediatrics.
    1997;156(10):758-63.
    28. imaging and endocrine study. Hormone Research in Paediatrics. 1990;34(5-6):189-92.
    29. Hanew K, Tachibana K, Yokoya S, Fujieda K, Tanaka T, Igarashi Y, et al. Clinical characteristics, etiologies
    and pathophysiology of patients with severe short stature with severe GH deficiency: questionnaire study
    on the data registered with the foundation for growth science, Japan. Endocrine journal. 2006;53(2):259-
    65.64
    30. Binder G, Nagel B ,Ranke M, Mullis P. Isolated GH deficiency (IGHD) type II: imaging of the pituitary
    gland by magnetic resonance reveals characteristic differences in comparison with severe IGHD of unknown
    origin. European journal of endocrinology. 2002;147(6):755-60.
    31. Dietrich RB, Lis LE, Greensite FS, Pitt D. Normal MR appearance of the pituitary gland in the first 2 years
    of life. AJNR Am J Neuroradiol 1995; 16:1413.
    32. Maghnie M, Strigazzi C, Tinelli C, et al. Growth hormone (GH) deficiency (GHD) of childhood onset:
    reassessment of GH status and evaluation of the predictive criteria for permanent GHD in young adults. J
    Clin Endocrinol Metab 1999; 84:1324.
مجله دانشکده پزشکی دانشگاه علوم پزشکی مشهد
دوره 64، شماره 3
مرداد و شهریور 1400
صفحه 3410-3419

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