Transsphenoidal surgery for pituitary adenomas in pediatric patients: a multicentric retrospective study

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.

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References

  1. 1.

    Keil MF, Stratakis CA (2008) Pituitary tumors in childhood: update of diagnosis, treatment and molecular genetics. Expert Rev Neurother 8(4):563–574. https://doi.org/10.1586/14737175.8.4.563

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Webb C, Prayson RA (2008) Pediatric pituitary adenomas. Arch Pathol Lab Med 132(1):77–80. https://doi.org/10.1043/1543-2165(2008)132[77:PPA]2.0.CO;2

    Article  PubMed  Google Scholar 

  3. 3.

    Guaraldi F, Storr HL, Ghizzoni L, Ghigo E, Savage MO (2014) Paediatric pituitary adenomas: a decade of change. Horm Res Paediatr 81(3):145–155. https://doi.org/10.1159/000357673

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Locatelli D, Massimi L, Rigante M, Custodi V, Paludetti G, Castelnuovo P, Di Rocco C (2010) Endoscopic endonasal transsphenoidal surgery for sellar tumors in children. Int J Pediatr Otorhinolaryngol 74(11):1298–1302. https://doi.org/10.1016/j.ijporl.2010.08.009

    Article  PubMed  Google Scholar 

  5. 5.

    Jiao W, Huang Y, Sun W, Lei T (2017) Microscopic transnasal transsphenoidal surgery for pediatric pituitary adenomas. J Craniofac Surg 28(4):1010–1012. https://doi.org/10.1097/SCS.0000000000003632

    Article  PubMed  Google Scholar 

  6. 6.

    Kunwar S, Wilson CB (1999) Pediatric pituitary adenomas. J Clin Endocrinol Metab 84(12):4385–4389. https://doi.org/10.1210/jcem.84.12.6240

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Jackman S, Diamond F (2013) Pituitary adenomas in childhood and adolescence. Pediatr Endocrinol Revi: PER 10(4):450–459

    Google Scholar 

  8. 8.

    Biller BM, Grossman AB, Stewart PM, Melmed S, Bertagna X, Bertherat J, Buchfelder M, Colao A, Hermus AR, Hofland LJ, Klibanski A, Lacroix A, Lindsay JR, Newell-Price J, Nieman LK, Petersenn S, Sonino N, Stalla GK, Swearingen B, Vance ML, Wass JA, Boscaro M (2008) Treatment of adrenocorticotropin-dependent Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab 93(7):2454–2462. https://doi.org/10.1210/jc.2007-2734

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Personnier C, Cazabat L, Bertherat J, Gaillard S, Souberbielle JC, Habrand JL, Dufour C, Clauser E, SainteRose C, Polak M (2011) Clinical features and treatment of pediatric somatotropinoma: case study of an aggressive tumor due to a new AIP mutation and extensive literature review. Horm Res Paediatr 75(6):392–402. https://doi.org/10.1159/000327831

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Chivukula S, Koutourousiou M, Snyderman CH, Fernandez-Miranda JC, Gardner PA, Tyler-Kabara EC (2013) Endoscopic endonasal skull base surgery in the pediatric population. J Neurosurg Pediatr 11(3):227–241. https://doi.org/10.3171/2012.10.PEDS12160

    Article  PubMed  Google Scholar 

  11. 11.

    Massimi L, Rigante M, D'Angelo L, Paternoster G, Leonardi P, Paludetti G, Di Rocco C (2011) Quality of postoperative course in children: endoscopic endonasal surgery versus sublabial microsurgery. Acta Neurochir 153(4):843–849. https://doi.org/10.1007/s00701-010-0929-6

    Article  PubMed  Google Scholar 

  12. 12.

    Ciccarelli A, Daly AF, Beckers A (2005) The epidemiology of prolactinomas. Pituitary 8(1):3–6. https://doi.org/10.1007/s11102-005-5079-0

    Article  PubMed  Google Scholar 

  13. 13.

    Eren E, Yapici S, Cakir ED, Ceylan LA, Saglam H, Tarim O (2011) Clinical course of hyperprolactinemia in children and adolescents: a review of 21 cases. J Clin Res Pediatr Endocrinol 3(2):65–69. https://doi.org/10.4274/jcrpe.v3i2.14

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, Wass JA, Endocrine S (2011) Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96(2):273–288. https://doi.org/10.1210/jc.2010-1692

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Storr HL, Alexandraki KI, Martin L, Isidori AM, Kaltsas GA, Monson JP, Besser GM, Matson M, Evanson J, Afshar F, Sabin I, Savage MO, Grossman AB (2011) Comparisons in the epidemiology, diagnostic features and cure rate by transsphenoidal surgery between paediatric and adult-onset Cushing’s disease. Eur J Endocrinol 164(5):667–674. https://doi.org/10.1530/EJE-10-1120

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Batista DL, Riar J, Keil M, Stratakis CA (2007) Diagnostic tests for children who are referred for the investigation of Cushing syndrome. Pediatrics 120(3):e575–e586. https://doi.org/10.1542/peds.2006-2402

    Article  PubMed  Google Scholar 

  17. 17.

    Magiakou MA, Mastorakos G, Oldfield EH, Gomez MT, Doppman JL, Cutler GB Jr, Nieman LK, Chrousos GP (1994) Cushing’s syndrome in children and adolescents. Presentation, diagnosis, and therapy. N Engl J Med 331(10):629–636. https://doi.org/10.1056/NEJM199409083311002

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Pandey P, Ojha BK, Mahapatra AK (2005) Pediatric pituitary adenoma: a series of 42 patients. J Clin Neurosci 12(2):124–127. https://doi.org/10.1016/j.jocn.2004.10.003

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Growth Hormone Research S, Pituitary S (2004) Biochemical assessment and long-term monitoring in patients with acromegaly: statement from a joint consensus conference of the Growth Hormone Research Society and the Pituitary Society. J Clin Endocrinol Metab 89(7):3099–3102. https://doi.org/10.1210/jc.2003-031138

    CAS  Article  Google Scholar 

  20. 20.

    Yamaguchi-Okada M, Inoshita N, Nishioka H, Fukuhara N, Yamada S (2012) Clinicopathological analysis of nonfunctioning pituitary adenomas in patients younger than 25 years of age. J Neurosurg Pediatr 9(5):511–516. https://doi.org/10.3171/2012.1.PEDS11330

    Article  PubMed  Google Scholar 

  21. 21.

    Chao CC, Lin CJ (2014) Pituitary apoplexy in a teenager--case report. Pediatr Neurol 50(6):648–651. https://doi.org/10.1016/j.pediatrneurol.2014.02.004

    Article  PubMed  Google Scholar 

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Correspondence to Pierlorenzo Veiceschi.

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Locatelli, D., Veiceschi, P., Castelnuovo, P. et al. Transsphenoidal surgery for pituitary adenomas in pediatric patients: a multicentric retrospective study. Childs Nerv Syst 35, 2119–2126 (2019). https://doi.org/10.1007/s00381-019-04179-z

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Keywords

  • Pediatric pituitary adenomas
  • Endoscopic endonasal transsphenoidal surgery
  • Transsphenoidal microsurgery
  • Remission
  • Outcome
  • Skull base