Magnetic Resonance Imaging (MRI) And Multiple Hormone Evaluation In Children With Pituitary Stalk Interruption Syndrome

Objective: To explore the relationship between MRI and pituitary-target hormones and to investigate the dynamic changes in hormone levels after hormone replacement therapy (HRT) in patients with pituitary stalk interruption (PSI) syndrome (PSIS).Methods: 59 patients (male 50, female 9)with PSlS(group A) were included in this study, aged 14.5±4.6 years, bone age (BA) 8.1±3.0 years. Forty male patients aged≥11 years from Group A were also evaluated separately (Group B). The control groups comprised 90 and 44 age- and sex-matched healthy children, respectively. The 59 patients in Group A were subdivided into two groups according to the appearance of the pituitary stalk on MRI: Grade I: partial PSIS, and Grade II: complete PSIS Serum levels of insulin-like growth factor-1 (IGF-1), free-thyroxine (FT4), thyroid stimulating hormone(TSH), adrenocorticotropic hormone(ACTH), cortisol(COR) were measured in 59 patiens with PSIS at the time of 0,1,3 months and every three months thereafter and follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL),testosterone (To), and estradiol(E2) were determined in group B and when needed thereafter.Results: There were significant difference between the two grades in the number and severity of pituitary hormone deficiencies (P<0.001-0.05). The peak GH level was less than 5μg/L in all 59 patients with PSIS. The serum IGF-1, FT4, ACTH and COR levels in Group A were significantly lower than those in Control A before treatment and TSH, ACTH and COR were lower after HRT. In Group B, the serum FSH, LH, and T levels were significantly decreased in all patients (100%) (P<0.001); however, E2 and PRL were significantly increased (P<0.001) compared with the Control Group B. E2 and PRL levels were increased in 25 (55%) and 20 (50%) cases, respectively.Conclusion: PSIS and its severity can be confirmed by MRI. PSIS can result in multiple pituitary hormone deficiency, which requires total HRT, which should be started at appropriate times and dosages to improve the quality of life and normal growth of the patient and to avoid adverse effects.