Background: Pituitary Radiological study is important to evaluate hypothalamus/hypophisis axis
problems. There are studies that describe correlation between pituitary radiological
abnormalities and hipopituitarism at general population, but few studies describe
neuroradiological abnormalities after traumatic brain injury in pediatric population,
and, when they do, it´s only at isolated case reports.
Objective: Studying routine traumatic brain injured patients’ magnetic resonance images (MRI),
evaluating pituitary morphology and volume in a pediatric population.
Methods: It is a longitudinal retrospective cases serie study, including 78 children and adolescents
that are being followed at our Rehabilitation Center between 2009 and 2021. MRI Technique
1,5 or 3,0 millimeter contiguous sagittal and coronal plain through the sella were
obtained using superconducting MRI units. A Developmental and Rehabilitation Pediatrician
has been trained by a Neurorradiologist and performed at the morphological pituitary
analysis. Pituitary volume was measured using the formula: coronal width X coronal
height X sagital width X 0,5. The results were compared to pre-existing parameters
for age and sex. We used the Program AquariusNet Viwer (AqNet) Versão V4.4.13.P4 (522).
Results: We studied 47 males and 31 females. Some patients had more than one sequential study,
so, totally, we evaluated 151 images. Age at MRI test went from 11 months old to 18
years old. Age at traumatic brain injury went from 0,2 to 16,9 years old. Time after
traumativ brain injury went from 0,2 to 14 follow up years. We found pituitary abnormalitie
at 29 from 123 MRI exams (23%) or in 25 from 74 patients (32%). All patients with
radiological pituitary abnormalities had previous severe traumatic brain injury, according
to Glasgow Coma Scale. From those patients, 72% were females. We found two “empty
sella syndrome” situations, one caused by “pituitary stalk transection syndrome”;
one pituitary cist (Rathke); and 22 cases with pituitary volume inferior to normal
references. with pituitary hormone deficiency. These abnormalities are more prevalent
in MPHD. In both adults and children, ectopic posterior pituitary bright spot (EPPBS)
at the median eminence was a universal finding in all patients.
Conclusions: Structural pituitary abnormalities have been found in 32% of our patients. It is
important to closely follow- up these patients in the long-term so that their natural
history of progressive radiological and hormonal deterioration can be ascertained.
