Diagnostic Yield of Brain MRI in Pediatric Short Stature: Hypothalamic-Pituitary Lesions and Incidental Findings in Real-World Practice.

Authors

Mustafa Zubeidat, Tamer Sobeh, Shai Shrot

Published in

Clinical endocrinology. Sep 10, 2026. Epub Sep 10, 2026.

Abstract

Brain MRI is widely performed in children with short stature or suspected growth hormone deficiency(GHD) to exclude hypothalamic-pituitary (HP) pathology, yet its diagnostic yield in routine practice is uncertain. We aimed to evaluate the prevalence, clinical significance, and distribution of HP and extrahypothalamic abnormalities in a large real-world pediatric referral cohort, and to assess the incremental diagnostic value of gadolinium contrast and pituitary morphometry.
We retrospectively reviewed 330 children (mean age: 9.2 ± 3.7 years; 60.3% boys) who underwent pituitary-protocol brain MRI between 2011 and 2024. Clinical presentation was classified as isolated short stature/suspected GHD or complex endocrine/neurologic features. Imaging findings were categorized as HP or non-HP, and classified as clinically significant (major/minor) or non-significant. Pituitary height was measured relative to age- and sex-adjusted norms.
Clinically significant abnormalities were identified in 22 children (6.7%), including four major lesions (1.2%). HP abnormalities were present in 30 patients (9.1%), with 11 (3.3%) clinically significant: eight microadenomas and three large sellar masses. Non-HP abnormalities occurred in 41 children (12.4%); 11 (3.3%) were clinically significant, including white matter changes, Chiari I malformation, and subependymal heterotopia. A suspected thalamic tumor represented the only major non-HP lesion. Notably, most major abnormalities occurred in children without complex endocrine presentations.
Among children evaluated for short stature or suspected GHD, clinically significant MRI abnormalities were uncommon and major HP pathology was rare. Nonetheless, the few high-impact lesions identified carried critical management implications, including contraindication to GH therapy and neurosurgical referral, often in children with otherwise uncomplicated presentations. In a pediatric population where delayed diagnosis may adversely affect growth, pubertal development, and treatment safety, these findings support a risk-adapted imaging strategy that preserves diagnostic vigilance while promoting responsible resource utilization.

PMID:
42720523
Bibliographic data and abstract were imported from PubMed on 10 Sep 2026.

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