Endocrine Abstracts

Multiple pituitary hormone deficiency (MPHD) associates variable misleading hypothalamic-pituitary imaging (MRI) aspects, with unpredictable dynamics until puberty, which requires a differential diagnosis with acquired pituitary changes that can modify subsequent case management. The patient, aged 7 years and 4 months, with no significant personal or hereditary antecedents, presented at the age of 5 years and 7 months to the Iasi Endocrinology Clinic for severe short stature (-4.89DS compared to the average height for the age and sex). Through a biological panel, pediatric and genetic consultation, alternative causes of short stature were excluded and endocrinologically, MPHD is confirmed along the thyrotropic and somatotropic axes. The radiograph of the fist illustrates the delayed bone age with 4 years compared to the chronological age and the hypothalamic-pituitary MRI describes the asymmetric pituitary gland with a right paramedian nodular area of 5/5/5 mm that appears in isosignal T1, hyposignal T2, with contrast asymmetry in the sequences made in dynamics, with a small late peripheral uptake of contrast, suggestive of pituitary microadenoma; pituitary stalk not deviated. The PROP1 mutation is the most common cause of congenital pituitary hormone deficiency, whose clinical, biological and imaging presentation pattern aligns with that of the discussed patient up to now. Thus, a neurosurgical consultation is performed; it establishes the interpretation of the imaging aspect in the context of intense regional contrast, through the development of the intercavernous sinuses. Tumor markers AFP, LDH and bHCG (within normal limits) exclude the tumor origin of the pituitary formation, elements that allow hGH substitution, the patient presenting a favorable clinical and biological evolution after 18 months of treatment. The particularity of the case consists in the differential diagnosis of the pituitary imaging aspect in pediatric cases for the establishment of therapeutic and follow-up conduct.