MRI Insights into the Hypothalamic-Pituitary Axis in Children with Central puberty related disorders

Abstract

<title>Abstract</title> Background Magnetic resonance imaging of the brain and pituitary gland has become an exceedingly helpful tool in the evaluation of children suffering from central precocious or delayed puberty with a high capability of detecting possible causative intra cranial pathologies, however the routine use of MRI for the evaluation of all children suffering these conditions has longly been debatable. Objective To determine the incidence of abnormal hypothalamic-pituitary axis imaging findings in children with puberty related disturbances and correlate between the imaging findings and the clinical and hormonal profile of the affected children Materials and methods A total of 75 children suffering from central disturbance of their pubertal timing were evaluated by MRI; 44 children diagnosed with precocious puberty and 31 children diagnosed with delayed puberty. MRI results were correlated with basal LH level and basal LH/FSH ratio in both groups and with Tanner stage in children with precocious puberty and with the pattern of pituitary hormonal disturbance in children with delayed puberty. Results A high prevalence of abnormal MRI results was detected in both groups; 63.6% in precocious puberty group (group I) and 67.7% in delayed puberty group (group II). The highest proportion of abnormalities was detected in the hypothalamic-pituitary axis in both groups; 92.9% and 100% respectively. Remarkably the prevalence of abnormal MRI results in females aged 6–8 years old in precocious puberty group was higher than both males and females aged less than 6 years old and the only detected case of supra sellar adamantinomatous craniopharyngioma was detected in a female aged 6–8 years old. Abnormal MRI results did not correlate with basal LH level or LH/FSH ratio in both groups, neither with Tanner stage in precocious puberty group but they had a strong positive correlation with combined hormonal disturbance/pan hypopituitarism in cases with delayed puberty. Conclusion MRI of the hypothalamic-pituitary axis is recommended in all cases with precocious puberty including females aged 6–8 years old and all cases of delayed puberty suffering from combined hormonal disturbance/pan hypopituitarism. MRI evaluation of delayed puberty cases with isolated hypogonadotrophic hypogonadsism can be watchfully postponed until males are older than 15 and females are older than 14 years old.