To avoid missing a tumor, the importance of administering MRI in children with pediatric growth hormone deficiency (GHD) and peak GH levels <5 ng/mL cannot be overemphasized, according to a study published in Growth Hormone & IGF Research. Although current guidelines indiscriminately recommend MRI of the pituitary gland in GHD, the relationship between abnormal MRI, most importantly a tumor, and peak GH levels is not well known. Therefore, researchers conducted a retrospective chart review where they collected pituitary MRI results of 399 children aged 3-16 with GHD and divided them into three groups according to peak stimulated GH levels (≤5, 5-7.4 and 7.5-10 ng/mL, groups A, B, and C, respectively). Clinical and MRI findings were compared between the groups. The study team found abnormal MRI in 36.9% of group A subjects, compared to group B (16.7%) and group C (17.0%). Children with multiple pituitary hormonal deficiencies (MPHD) had a higher rate of abnormalities than those with isolated GHD. Children with isolated GHD were more likely to have abnormal MRI with peak GH level < 5 ng/mL compared to those with levels, 5-7.4 and 7.5-10 ng/mL. Four children in group A had a craniopharyngioma. Although abnormal MRI was found in all three study groups, it was more likely at GH level < 5 ng/mL and in children with MPHD.