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Dr Basu
Dr Basu, Experienced Specialist
Category: Health
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Experience:  MD
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My son is six years old. He weighs 36 pounds. He has been

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My son is six years old. He weighs 36 pounds. He has been diagnosed with Failure to thrive, short stature, Seizure disorder (has had two seizures about a year apart), Aspergers, ADHD inattentive, dysthymia, generalized anxiety and anemia.
His MRI shows a slight, heterogenous enhancement of the pituitary with no discreet, identifiable lesion. What should I be looking for in the blood results?
Any other thoughts/interpretations?
mysticdoc :

The views expressed by me are for educational purposes only and do not establish a doctor patient relationship.

mysticdoc :

Hello,

mysticdoc :

Thanks for your question.

mysticdoc :

I am sorry hear about your son's comorbidities.

mysticdoc :

The heterogenous enhancement may not be clinically significant.

Customer:

Why not?

mysticdoc :

Clinically we look for serum TSH level, serum cortisol and ACTH level, growth hormone level, IGF1 level, testosterone level, prolactin level, LH and FSH level.

mysticdoc :

The size of pituitary is normal and there is no identifiable lesion.

mysticdoc :

If the above hormone levels are in noremal range then there is no pituitary problem.

Customer:

checking...

mysticdoc :

ok

mysticdoc :

please reply if you have any further question.

Customer:

TSH 1.13cortisol 6.3,

mysticdoc :

normal

Customer:

z score -1.4 ketones +1, prolactin 10.4, what is stage 1, 2-3, and 4-5? what are abbreviations for others?

mysticdoc :

z-score is to assess osteoporosis or bone loss.

mysticdoc :

prolactin is normal.

mysticdoc :

others should be noted as I mentioned above.

mysticdoc :

stages I am not clear --as this is not associated with prolactin or z score

Customer:

it says Test stages.

Customer:

Sorry- "Test name" stages and then there is an "in" and "out" of range column.

mysticdoc :

ok -- that is the degree of abnormal result only if the values are out of range on the upper side.

Customer:

Out of range: neg or =10, neg or =6.1, 2.8-11. What does this mean?

mysticdoc :

do you know the hormone it is being meausred with these ranges?

Customer:

could it be prolactin tanner stages?

mysticdoc :

yes that makes sense like tanner stages for prolactin.

Customer:

there are in and out of range? is my son in or out?

mysticdoc :

your son is still in the range.

mysticdoc :

he is in stage 4-5

Customer:

Last questions- what is the enhancement then? what is there? could it be down his spine (MRI was only of brain). I thought this enhancement would be the answer to the growth issue (He has been monitored by gastro, pedi, endo, since he was three). I do not understand how there is something on the pituitary and he is not growing, but they do not correlate.

mysticdoc :

Pituitary is a vascular organ with high blood flow.

mysticdoc :

This will show as enhancement in the MRI.

mysticdoc :

since there is no lesion, this is a normal finding.

mysticdoc :

even though the pituitary looks normal, this may still function suboptimally.

mysticdoc :

His growth hormone level anf IGF1 level should be checked.

mysticdoc :

growth hormone deficiency has not been checked.

mysticdoc :

please request for that test.

Customer:

We need a new endo- I can't believe she did not do IGF1- my son has a growth issue.

mysticdoc :

yes definitely--I am surprised.

Customer:

Thank You-

mysticdoc :

This should be treatable.

mysticdoc :

Best wishes,

mysticdoc :

My goal is to provide you with good or excellent service – if you feel you have gotten anything less, please reply back, I am happy to address follow-up questions. Thank you for your business!

Customer:

I think I LOVE you!!!! :) Will sleep better tonight- till we see the neurosurgeon next week. Endo wants him to look at MRI.

mysticdoc :

very welcome.

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