53- What is MRI “ tetrad ” associated with GHD / MPHD?
The MRI tetrad includes small sella, hypoplastic/absent anterior pituitary,
redundant/absent pituitary stalk, and ectopic/absent posterior pituitary bright
spot. The presence of these structural defects in a short child is highly predic-
tive of multiple pituitary hormone defi ciency; hence, only a single GH dynamic
test is required to establish the diagnosis of GHD in these patients. The pres-
ence of these abnormalities is also suggestive of irreversible GHD; therefore,
GH dynamic tests may not be required during transition to adulthood in these
patients (Fig. 2.4 ).a bFig. 2.3 ( a ) A 6-year-old boy with short stature ( b ) axial plain CT scan showing dense suprasellar
chunky calcifi cation ( red arrow ) in the same patient suggestive of craniopharyngioma
2 Disorders of Growth and Development: Diagnosis and Treatment