Routine brain MRI recommended for children with growth hormone deficiency

Although certain biomarkers, such as insulin-like growth factor-I (IGF-I), IGF-I standard deviation score (SDS), insulin-like growth factor binding protein 3 (IGFBP3), and growth hormone (GH) peak levels, and GH peak levels, can help predict brain abnormalities in children with growth hormone deficiency (GHD), they are not sufficient to detect all cases, according to a study that recommends routine brain MRI for all children diagnosed with GHD to identify potential pituitary or intracranial abnormalities accurately.

The retrospective review analyzed the medical records and brain MRIs of 95 pediatric patients with GHD. Abnormal MRIs were detected in 14.7% of cases, including pituitary hypoplasia (10.5%) and pituitary stalk interruption syndrome (4.2%). Key laboratory markers, including IGF-1, IGF-1 SDS, IGFBP3, were significantly lower in patients with abnormal brain MRIs.

The study found that IGF-1 SDS had the highest predictive value for detecting abnormalities, with a sensitivity of 85% and specificity of 71.4% at a cutoff of less than -1.365. Other biomarkers, such as IGF-1, IGFBP3, and GH peak levels, also showed over 80% sensitivity with specific thresholds.

Despite these findings, the authors concluded that laboratory markers alone are insufficient to identify all brain abnormalities. They recommend routine brain MRI for children diagnosed with GHD to ensure accurate detection and management of potential pituitary or intracranial abnormalities.

Reference
Jung HJ, Kim JR, Yu J. Pituitary abnormalities in patients with pediatric growth hormone deficiency in a single tertiary center. Ann Pediatr Endocrinol Metab. 2024;29(6):365-370. doi: 10.6065/apem.2448070.035. Epub 2024 Dec 31. PMID: 39778405; PMCID: PMC11725637.