ABSTRACT
INTRODUCTION: Pediatric pituitary adenomas are rare lesions. Incidence is reported between 1 and 10% of all childhood brain tumors and between 3 and 6% of all surgically treated adenomas. Although pituitary adenomas present with symptoms of hormone hypersecretion or neurological disruptions secondary to mass effect, they are almost constantly benign. Characteristics of patients may vary in different studies according to age, gender, size of adenoma, hormonal activity, and recurrence rates. METHODS: Data on consecutive pediatric patients who were operated for pituitary adenoma with endoscopic endonasal transsphenoidal surgery (EETS) and transsphenoidal microsurgery (TMS) in the Department of Neurosurgery, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey, in the Neurosurgical Unit of the San Matteo Hospital, Pavia, Italy, and in the Division of Neurological Surgery Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy, between July 1997 and May 2018, were analyzed. Twenty-seven patients (11 males and 16 females), who were 18 years old or younger at the time of surgery, were included in the study. Medical records, images, and operative notes of patients were retrospectively reviewed. RESULTS: There were 16 females (59.3%) and 11 males (40.7%). Mean age was 15.3 ± 3.3 (4-18). Thirty-two surgical procedures were performed for 27 patients (6 children required second operation). Thirteen patients (48.14%) had Cushing's disease (CD), 5 patients (18.5%) had growth hormone (GH)-secreting adenoma, 5 patients (18.5%) had prolactinoma, and 4 patients (14.8%) had non-functional adenoma. Twenty-two patients (81.4%) met remission criteria, and 5 patients (18.5%) did not meet remission criteria. Four patients met remission criteria after the second operation. CONCLUSION: Transsphenoidal approach affords effective release of mass effect and not only restoration but also perpetuation of normal endocrine functions in the majority of pediatric pituitary adenoma patients. Satisfactory results are reported with both EETS and TMS in the literature. Despite the technical difficulties in pediatric age, transsphenoidal resection of adenoma is still the mainstay treatment that provides cure in pediatric patients.
Subject(s)
Adenoma/surgery , Microsurgery/methods , Neuroendoscopy/methods , Pituitary Neoplasms/surgery , Sphenoid Bone , ACTH-Secreting Pituitary Adenoma/pathology , ACTH-Secreting Pituitary Adenoma/surgery , Adenoma/pathology , Adolescent , Adrenal Insufficiency/epidemiology , Cerebrospinal Fluid Leak/epidemiology , Cerebrospinal Fluid Leak/surgery , Child , Child, Preschool , Diabetes Insipidus/epidemiology , Female , Growth Hormone-Secreting Pituitary Adenoma/pathology , Growth Hormone-Secreting Pituitary Adenoma/surgery , Humans , Hypopituitarism/epidemiology , Male , Meningism/epidemiology , Nasal Cavity , Natural Orifice Endoscopic Surgery/methods , Pituitary Neoplasms/pathology , Postoperative Complications/epidemiology , Prolactinoma/pathology , Prolactinoma/surgery , Retrospective Studies , Treatment Outcome , Tumor BurdenABSTRACT
Sixty-nine children were identified and evaluable. Forty-one (60%) presented with hypotension and/or abnormal neurological signs. In 34 (49%) a petechial rash was present on admission. Of note, 13 (19%) had a non-petechial rash, and rash was absent in 19 (28%). Twenty-one (30%) presented with meningism or meningitis. In one child the illness was so mild that the child was discharged prior to making a diagnosis. Five children died (7%). Sixty-three cases (91%) were diagnosed by blood or cerebrospinal fluid culture; these investigations remain the mainstay of diagnosis.
Subject(s)
Meningococcal Infections/diagnosis , Meningococcal Infections/epidemiology , Neisseria meningitidis , Adolescent , Child , Child, Preschool , Exanthema/diagnosis , Exanthema/etiology , Female , Humans , Infant , Infant, Newborn , Male , Meningism/diagnosis , Meningism/epidemiology , Meningism/etiology , Meningitis, Meningococcal/diagnosis , Meningitis, Meningococcal/epidemiology , Meningitis, Meningococcal/etiology , Meningococcal Infections/complications , Retrospective Studies , United Kingdom/epidemiologyABSTRACT
All admissions to the Aberdeen Infection Unit over a period of 12 months have been analysed. Forty per cent of the patients proved to have non-infectious conditions although most were referred as having an infectious disease. Those patients with infectious diseases were younger and had a shorter stay in hospital. Also there was seasonal variation in the time of their admission as well as a low mortality rate when compared with older patients with non-infectious disease admitted over the same period. Cross infection did not arise in spite of patients sharing accommodation.
Subject(s)
Hospital Units , Infections , Patient Isolation , Cross Infection/epidemiology , Cross Infection/etiology , Diarrhea/epidemiology , Diarrhea/etiology , Female , Gastroenteritis/epidemiology , Hepatitis, Viral, Human/epidemiology , Humans , Infections/complications , Infections/epidemiology , Jaundice/epidemiology , Jaundice/etiology , Male , Meningism/epidemiology , Meningism/etiology , Patient Admission , Pharyngitis/epidemiology , Pharyngitis/etiology , Scotland , SeasonsABSTRACT
Nuchal rigidity, which may be a sign of meningitis, was found in 35 per cent of geriatric patients on acute-care and rehabilitation wards and in 13 per cent of younger patients on an acute-care ward. It was significantly associated with cerebrovascular disease, confusion, abnormal plantar responses, and primitive reflexes. Elderly patients who have nuchal rigidity with no history of neurologic or cognitive disorders should be investigated for meningitis.
