Hypothalamic-pituitary dysfunction in growth hormone-deficient patients with pituitary abnormalities

M. Maghnie, F. Triuzi, D. Larizza, P. Preti, C. Priora, G. Scotti, F. Severi

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Abstract

Hypothalamic-pituitary function was studied in 45 patients with idiopathic GH deficiency (GHD), 33 of whom had pituitary abnormalities on magnetic resonance imaging: pituitary hypoplasia, undescended stalk and ectopia of the posterior lobe in 8 patients with isolated GHD (IGHD) (group I) and in 12 patients with multiple pituitary hormone deficiency (MPHD) (group II); isolated pituitary hypoplasia in 13 patients with IGHD (group III); no evidence of pituitary abnormalities in the remaining 12 patients with IGHD (group IV). Sellar and pituitary volumes were significantly lower in groups I, II, and III than in group IV (P <0.001). No significant differences were observed between group I and group II in the GH response to GHRH1-44 expressed both as peak serum GH and area under the curve. Mean GH peak in group III and IV was significantly higher than that in group I (P <0.005) and II (P <0.001), as were the mean AUC (P <0.005), suggesting hypothalamic defect. Delayed peak serum TSH after TRH was found in all patients of group II, and overt hypothyroidism in 11 of them. Furthermore, basal hyperprolactinemia was present in 6 patients and adrenal insufficiency in 7 cases of group II. Finally, a reduced response of FSH to GnRH was observed in all these patients (P <0.005 vs. each of the other groups), and clinical hypogonadism was present in all of them. We suggest that: 1) A high incidence of pituitary abnormalities seems to be present in idiopathic GHD patients; 2) Pituitary hormone deficiencies are more dependent on the type of the hypothalamic-pituitary abnormality than on the size of the pituitary per se: the association of pituitary hypoplasia, undescended stalk and ectopia of the posterior lobe should possibly be considered a distinct entity reflecting an early abnormality in hypothalamic development; 3) The majority of patients with IGHD or MPHD probably have a primary hypothalamic releasing hormone deficiency even if pituitary hypoplasia is associated; 4) Magnetic resonance imaging may have a role in the diagnosis and prognosis of patients with GHD through differentiation between patients who are at risk for developing MPHD vs. those who are candidates for having a persistently isolated GHD.

Original languageEnglish
Pages (from-to)79-83
Number of pages5
JournalJournal of Clinical Endocrinology and Metabolism
Volume73
Issue number1
Publication statusPublished - 1991

Fingerprint

Pituitary Hormones
Growth Hormone
Pituitary Hormone-Releasing Hormones
Magnetic resonance
Gonadotropin-Releasing Hormone
Pituitary Dwarfism
Magnetic resonance imaging
Imaging techniques
Defects
Area Under Curve
Magnetic Resonance Imaging
Adrenal Insufficiency
Hyperprolactinemia
Hypogonadism
Hypothyroidism
Serum

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism

Cite this

Hypothalamic-pituitary dysfunction in growth hormone-deficient patients with pituitary abnormalities. / Maghnie, M.; Triuzi, F.; Larizza, D.; Preti, P.; Priora, C.; Scotti, G.; Severi, F.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 73, No. 1, 1991, p. 79-83.

Research output: Contribution to journalArticle

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AU - Maghnie, M.

AU - Triuzi, F.

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AU - Scotti, G.

AU - Severi, F.

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