Signal Intensity Reduction May Be Prior to Height or Volume Loss in Pituitary Gland MRI of Beta-Thalassemic Patients with Hypogonadotropic Hypogonadism

"nIntroduction: Pituitary iron overload in patients with transfusion-dependent beta-thalassemia may lead to delayed puberty. MRI has the potential to estimate excessive iron accumulation in the pituitary gland by measuring its dimensions or signal intensity. This study investigates the association of pituitary MRI findings and the pubertal status in thalassemic patients as well as demonstrating any priority to reveal these manifestations. "nMaterials and Methods: Twenty seven beta-thalassemic patients, aged 15-24 years, including 13 patients with delayed puberty (Group A) and 14 normal puberty (Group B) were enrolled. They were matched by age, gender, duration of transfusion and chelation therapy. Thirty eight age and sex adjusted healthy subjects were also included as the control group (Group C). All participants underwent pituitary MRI using a 1.5T unit. Pituitary-to-fat signal intensity ratios (SIR) were calculated from coronal T2-weighted images. Estimated pituitary volumes were measured using pituitary height, width and length. Data were expressed as mean± SD and analyzed using Student's t test. "nResults: The pituitary-to-fat SIRs were significantly lower in group A compared with group B (P<0.001) and likewise group B had statistically lower values than group C (P=0.03). The pituitary height and volume were significantly decreased in group A in comparison with group B (P=0.006 and P=0.002, respectively). No statistically significant difference in height and volume measurements was demonstrated between group B and C. "nConclusion: Pituitary MRI findings as signal intensity reduction and decrease in volume or height are useful markers to estimate pituitary dysfunction related hypogonadism in beta-thalassemic patients. Higher values of pituitary-to-fat SIRs in healthy subjects compared with thalassemic patients experiencing normal puberty indicate that signal reduction may be prior to height or volume loss and could be expected first on MRI.