Endocrine Outcomes In Central Diabetes Insipidus: the Predictive Value of Neuroimaging 'Mismatch Pattern'
| Autor: | Anna Elsa Maria Allegri, Anastasia Ibba, Giuseppa Patti, Marco Crocco, Mohamad Maghnie, Flavia Napoli, Daniela Fava, Marilea Lezzi, Deborah Bianco, Natascia Di Iorgi, Andrea Rossi, Maurizio Schiavone, Giovanni Morana, Andrea Calandrino, Angela Pistorio, Hanan F. Thiabat, Mariasavina Severino, Tiziana Camia, Domenico Tortora |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Pituitary gland Pathology Adolescent Endocrinology Diabetes and Metabolism Clinical Biochemistry Neurogenic Context (language use) Biochemistry Growth hormone deficiency Pituitary stalk Endocrinology Anterior pituitary Langerhans cell histiocytosis Internal medicine medicine Humans Central diabetes insipidus Posterior pituitary hyperintensity Child Child Preschool Diabetes Insipidus Neurogenic Female Histiocytosis Langerhans-Cell Pituitary Gland Retrospective Studies Magnetic Resonance Imaging Langerhans-Cell Preschool business.industry Biochemistry (medical) medicine.disease medicine.anatomical_structure Diabetes insipidus business Histiocytosis Neurogenic diabetes insipidus Diabetes Insipidus |
| Zdroj: | The Journal of clinical endocrinology and metabolism. 105(11) |
| ISSN: | 1945-7197 |
| Popis: | Context The etiology of central diabetes insipidus (CDI) in children is often unknown. Clinical and radiological features at disease onset do not allow discrimination between idiopathic forms and other conditions or to predict anterior pituitary dysfunction. Objective To evaluate the evolution of pituitary stalk (PS) thickening and the pattern of contrast-enhancement in relation with etiological diagnosis and pituitary function. Methods We enrolled 39 children with CDI, 29 idiopathic and 10 with Langerhans cell histiocytosis (LCH). Brain magnetic resonance images taken at admission and during follow-up (332 studies) were examined, focusing on PS thickness, contrast-enhancement pattern, and pituitary gland size; T2-DRIVE and postcontrast T1-weighted images were analyzed. Results Seventeen of 29 patients (58.6%) with idiopathic CDI displayed “mismatch pattern,” consisting in a discrepancy between PS thickness in T2-DRIVE and postcontrast T1-weighted images; neuroimaging findings became stable after its appearance, while “mismatch” appeared in LCH patients after chemotherapy. Patients with larger PS displayed mismatch more frequently (P = 0.003); in these patients, reduction of proximal and middle PS size was documented over time (P = 0.045 and P = 0.006). The pituitary gland was smaller in patients with mismatch (P < 0.0001). Patients with mismatch presented more frequently with at least one pituitary hormone defect, more often growth hormone deficiency (P = 0.033). Conclusions The PS mismatch pattern characterizes patients with CDI, reduced pituitary gland size, and anterior pituitary dysfunction. The association of mismatch pattern with specific underlying conditions needs further investigation. As patients with mismatch show stabilization of PS size, we assume a prognostic role of this peculiar pattern, which could be used to lead follow-up. |
| Databáze: | OpenAIRE |
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