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Pediatric Endocrine Imaging: A Case Study

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Pediatric Endocrine Imaging – Evaluation of the pituitary gland and a child with precocious puberty. Dr Priscilla Joshi Major Endocrine glands, which may need evaluation in children, are • Pituitary : hypophysis- hypothalamus axis • Thyroid • Parathyroid • Pancreas • Adrenals • Gonads- ovaries and testes This chapter would deal predominantly with imaging of the pituitary gland as well as evaluating a child with precocious puberty. The armamentarium of radiological investigations available to assess the structure of these organs in a patient with endocrine dysfunction are A) Conventional radiography B) Ultrasonography C) CT scan F) MRI The radiological investigations to assess function include: A) Radionuclide imaging (Scintigraphy) …show more content…

Stalk thickness >2.6 mm is suggestive of pathological infiltration. It shows intense post gadolinium enhancement due to lack of blood brain barrier. It should taper smoothly from largest portion at tuber cinereum to smallest portion at insertion into the neurohypophysis. Abrupt change in size should raise suspicion of a mass The normal pituitary volume The normal volume of the gland is age related . The height of the pituitary gland varies as follows : 4.5 +/- 2 at <6 weeks gestation to 4.5+/- 0.6 mm at 5-10 years 5 +/-2 in boys 10-20 years of age 8+/-2 in girls 10-20 years of age Volume of the pituitary gland, including the posterior pituitary ranges from 174+/- 118 cmm at 6 weeks to 2 years 184 to 214 +/- 145 cmm at 2 – 5 years 226 to 277 cmm +/- 188 at 5-10 years Pituitary Dysfunction Diabetes Insipidus This occurs due to dysfunction of the paraventricular or supraoptic nuclei of the hypothalamus. Despite infiltration of the nuclei the infundibulum may appear normal in size. Imaging of the hypothalamic region excludes a hypothalamic/infundibular mass. Imaging may reveal subtle findings or maybe normal at the time of initial

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Case Study 1 – The Endocrine System Christina D’Amico University of Saint Joseph Abstract A fifteen-year-old boy with many hormonal abnormalities starting at the age of eleven suffered from joint pain and swelling along with poor bone growth and development. He broke his left hip and had low levels of testosterone and high levels of growth hormone resulting in gigantism and later acromegaly.

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Next, they traced the external jugular vein and its tributary veins on the surface of the right side of the neck and head. On the left side where the sternomastoid was cut, the students then located the deeper vessels running alongside the trachea, internal jugular vein, and the common carotid artery. In the abdominal cavity, the groups then exposed and studied the hepatic portal vein and its tributaries. They then identified the tributaries of the post cava, the renal, adrenolumbar, iliolumbar, iliac, and caudal vessels. The arteries of the gonads then came off the abdominal aorta cranial where the spermatic arteries were found.

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The diagnostic steps for thyroid nodules in children and adolescents are not different from those in adults. A thyroid nodule can be discovered by a physician during a routine physical examination, discovered by patients themselves, or observed incidentally during imaging of the neck. However, the majority (75%) of pediatric patients with both benign and malignant nodules have asymptomatic neck masses 3. While some children with enlarged thyroid may present with symptoms of hypothyroidism which included bradycardia, fatigue, dry skin, decreased appetite, weight gain, hyperhidrosis, constipation, and tremors and cold intolerance, other may present with symptoms of hyperthyroidism which include tachycardia, weight loss with increased appetite, heat intolerance and increased sweating, diarrhea, and exophthalmia, some are

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After a few years, there was a tumor in her pituitary region. The tumor was secreting excessive amounts of growth hormone, casing symptoms to appear. She had enlarged hands and feet, coarsened, enlarged facial features, coarse, oily, thickened skin, and

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When chowing down on some delicious cat food, Mr. Kibbles, do to his old age suffered from a stroke. Which ended up having long lasting effects on his overall endocrine system. Although your friend Betty is very happy that Mr. Kibbles survived his stroke, she is still confused on what extent his endocrine system has been compromised. She has called on you, her trusty physiologist best friend to thoroughly explain exactly what is going on within Mr. Kibbles. Although the vet did give a basic outline of what is wrong with Mr. Kibbles, he did not use specifics.

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An unbalance in these hormones would cause changes in the function and structure of the gland. In the setting where there isn’t a sufficient amount of Thyroxin synthesized by the gland, there is an increase in TSH production. Over production of TSH causes hyperplasia of the gland just to match normal thyroid levels. This would then cause a goiter to form. When the goiter is grown significantly, pressure is put on the esophagus and trachea, causing respiratory

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Diagnosis: 1 - Raised T4 & T3 - Low TSH - Increased I131 uptake. - Thyroid stimulating immunoglobulin positive Histology: 1 - Macroscopic: o fleshy appearance o Absence of normal glossy look o Less colloid - Microscopic: o diffuse hyperplasia with cylindrical epithelial cells o Smaller follicles o Papillary outgrowths. Natural course1 - Most persist without treatment leading to further thyroid damage and a high mortality rate. - Rarely patients may go into spontaneous remission, these patients usually lose their abnormal immunoglobulins.

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Many people who suffer from a deficiency of thyroid hormone experience the discomfort and dis-ease this produces for years before seeking help. In diagnoses, doctors tend to stick with serum tests to check for the presence of thyroid hormone in the blood. Frequently, this returns an answer that misses the underlying condition. A more accurate test checks for the intracellular activity of calcium, magnesium and potassium.

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This can be illustrated over a period of time. Once an individual can see the progressive change in the organ’s function. For instance, an ultrasound Doppler can illustrate normal blood flow and impeded blood flow in the heart. Also, brain scans use functional imaging. A patient’s brain lights up in a scan when he/she answers yes/no questions or executes cognitive tasks such as counting or recognizing objects.

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Imaging of malignancies shows invasion of the adjacent structures (nerves, bone, skull base, meninges and adjacent cervical spaces) and capsule rapture in pleomorphic adenoma all of them are better viewed by MRI. Postgadolinium, fat-supporetd T1W images are preferred for determining the invasions. Malignancies are also characterized by ill-defined margins in post contrast images.

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The anterior pituitary is devoid of a nerve supply, but has a unique blood supply, a portal system. The hypothalamohypophyseal portal system begins in a series of capillaries in the median eminence of the hypothalamus sends blood via veins to the anterior lobe, where it ends in a series of capillaries. This portal system carries neurohormones from the hypothalamus to the anterior pituitary where they control the secretion of anterior lobe hormones. The anterior pituitary consists of five different endocrine cell types, identified by antibodies against pituitary hormones and capable of production and secretion of pituitary hormones: 1.

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