Clinical Features And Influencing Factors On Height Of Patients With Pituitary Stalk Interruption Syndrome

Background and PurposePituitary stalk interruption syndrome（PSIS）is a clinical syndrome characterized by hypopituitarism,with growth hormone deficiency（GHD）being the most common.And almost PSIS patients show short stature resulting from early persistent GHD.However,there are several patients maintain normal growth despite GHD.The study is aimed to analyze the clinical characteristics and the influencing factors on height of patients with PSIS.It is expected to discover possible mechanisms for PSIS patients reaching normal height.Subject and method93 cases of PSIS patients admitted to the First Affiliated Hospital of Zhengzhou University from May 2010 to February 2019 are selected,including 77 males and 16females.According to the height,the male and female patients are divided into two groups:47 males（9 females）in the normal height group;30 males（7 females）in the short stature group.Then it compares the differences between the normal group and the short group and analyze the influencing factors of height.ResultsOf the 93 patients,77（83%）is male,and the mean age is 22.74±6.13 years（range from 7 to 48）.The short stature accounts for 41.6%（37/89）,the average bone age difference is 7.0（0,14.5）years,and the average SD difference is-1.82±1.79.The proportion of GHD,hypogonadism,adrenal insufficiency,hypothyroidism,and hyperprolactinemia in 93 patients are respectively 96.43%,95.8%,58.1%,66.7%,and 33.3%.And the patients with three or more kinds hormone deficiency account for85.6%.Only one case is diagnosed with central diabetes insipidus.The results of pituitary MRI show that the average height of the anterior pituitary is 3.09±1.12mm;70.7%（65/93）of the patients have missing pituitary stalks,and the remaining patients have slender pituitary stalks;the ectopic pituitary stalks account for 66.7%（62/93）,which are most located in optic chiasma area.There is no significant difference between the short group and normal group about the GH baseline value,IGF-1 and GH treatment time.Age,body weight,BMI,total cholesterol（TC）,fasting insulin（Fins）,area under the curve of insulin(AUC_ins)and GH peak increase in normal group compared with short group of males（P<0.05）.But the male normal group has lower high density lipoprotein（HDL）,free thyroxine（FT₄）,follicle stimulating hormone（FSH）,testosterone（T）,and luteinizing hormone（LH）peak（P<0.05）.Female normal group shows higher age,body weight,BMI（P<0.05）,and lower TSH,FT4,FSH（P<0.05）.Linear correlation analysis and logistic regression analysis show that male height is positively correlated with age（r=0.514）,body weight（r=0.753）,BMI（r=0.344）,Fins（r=0.434）,AUCins（r=0.631）（P<0.05）,and negatively correlated with HDL（r=-0.246）,FT4（r=-0.267）,T（r=-0.045）,FSH（r=-0.324）,and LH peak（r=-0.261）（P<0.05）.The height of female patients is positively correlated with age（r=0.725）,body weight（r=0.834）,BMI（r=0.888）,AUCins（r=0.800）（P<0.05）,and FT4（r=-0.172）,FSH（r=-0.397）show a negative correlation（P<0.05）.Taking height as the dependent variable,and age,weight,TC,HDL,FT₄,TSH,FSH,T,LH peak,GH peak,Fins and AUC_ins as independent variables,multivariate logistic regression analysis result shows there is no certain factor as independent influencing factor of height in male and female PSIS patients（P>0.05）.ConclusionAlthough PSIS patients have GHD,their height can gradually increase with age and someone reach normal height.Many PSIS patients reaching normal height is possible that high levels of insulin caused by obese produces GH-like effects through the IGF-1 receptor acting on bones.Whether all PSIS patients require GH treatment needs further study.