Childhood Onset Pituitary Adenoma: Clinical Presentations and Outcomes of 24 Cases

ABSTRACT

PURPOSE: Our purpose was to evaluate the clinical presentations at diagnosis and treatment outcomes of functional pituitary adenoma (PA) and nonfunctional PAs (NFPA) in childhood and adolescence. METHODS: We performed a retrospective review of the medical records of patients diagnosed with PA before 18 years of age. RESULTS: The mean age at diagnosis of 24 patients (9 males, 15 females) was 12.3 years, and the mean follow-up period was 4.5 years. PAs were categorized as follows prolactinoma (n=7, 29.2%), adrenocorticotropic hormone secreting adenomas (n=4, 16.7%), growth hormone secreting adenomas (n=3, 12.5%), and NFPAs (n=10, 41.7%). The proportion of macroadenoma (n=13, 54.2%) was similar to that of microadenoma (n=11, 45.8%). Sixteen patients (66.7%) who were diagnosed with functional PA (including all prolactinomas), and two NFPAs underwent surgery due to mass effects. The patients who received surgery had a higher risk for hypopituitarism than those who did not (75.0% vs. 12.5%; P =0.008). Recurrence occurred in five patients, all of whom had residual tumors after surgery for macroadenoma. The degree of obesity at latest follow-up was associated with that at diagnosis (P <0.001). CONCLUSION: The prevalence of NFPAs was higher than that of previous reports, which was explained by higher detection of incidentalomas. Prolactinoma was the most common functional PA. Thorough investigation of symptoms related to hormone excess and hormone profiles is important for differential diagnosis and decision regarding treatment plan. Additionally, the regular follow up for relapse and endocrine deficit is mandatory in patients with PA, especially those who had received pituitary surgery.