Accessible Requires Authentication Published by De Gruyter February 23, 2021

Brain MRIs may be of low value in most children diagnosed with isolated growth hormone deficiency

Jessica Schmitt ORCID logo, Paul Thornton, Avni N. Shah, A. K. M. Falzur Rahman, Elizabeth Kubota, Patrick Rizzuto, Anshu Gupta, Sena Orsdemir and Paul B. Kaplowitz

Abstract

Objectives

Brain MRIs are considered essential in the evaluation of children diagnosed with growth hormone deficiency (GHD), but there is uncertainty about the appropriate cut-off for diagnosis of GHD and little data about the yield of significant abnormal findings in patients with peak growth hormone (GH) of 7–10 ng/mL. We aimed to assess the frequency of pathogenic MRIs and associated risk factors in relation to peak GH concentrations.

Methods

In this retrospective multicenter study, charts of patients diagnosed with GHD who subsequently had a brain MRI were reviewed. MRIs findings were categorized as normal, incidental, of uncertain significance, or pathogenic (pituitary hypoplasia, small stalk and/or ectopic posterior pituitary and tumors). Charges for brain MRIs and sedation were collected.

Results

In 499 patients, 68.1% had normal MRIs, 18.2% had incidental findings, 6.6% had uncertain findings, and 7.0% had pathogenic MRIs. Those with peak GH<3 ng/mL had the highest frequency of pathogenic MRIs (23%). Only three of 194 patients (1.5%) with peak GH 7–10 ng/mL had pathogenic MRIs, none of which altered management. Two patients (0.4%) with central hypothyroidism and peak GH<4 ng/mL had craniopharyngioma.

Conclusions

Pathogenic MRIs were uncommon in patients diagnosed with GHD except in the group with peak GH<3 ng/mL. There was a high frequency of incidental findings which often resulted in referrals to neurosurgery and repeat MRIs. Given the high cost of brain MRIs, their routine use in patients diagnosed with isolated GHD, especially patients with peak GH of 7–10 ng/mL, should be reconsidered.


Corresponding author: Assistant Professor, Jessica Schmitt, MD, Department of Pediatrics, University of Alabama at Birmingham, CPPII M30, 1600 7th Avenue South, Birmingham, AL, 35233, USA, Phone: +1 205 638 9107, E-mail:

  1. Research funding: None declared.

  2. Author contributions: PBK conceived the study. JS, PT, ANS, EK, PR, AG, SO, and PBK reviewed the medical records to collect the data. JS and AKMFR analyzed and interpreted data. JS and PBK drafted the manuscript. All authors reviewed the findings and approved of the final version of the manuscript.

  3. Competing interests: None declared.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: Research involving human subjects complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013), and has been approved by all involved institutional review boards (IRB); University of Alabama at Birmingham IRB, Cook Children’s Health Care System IRB, Memorial Hermann Health System IRB, Virginia Commonwealth University IRB, Loma Linda University IRB, and Children’s National Medical Center IRB.

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Received: 2020-10-05
Accepted: 2020-12-10
Published Online: 2021-02-23
Published in Print: 2021-03-26

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