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The epidemiology and management patterns of pediatric pituitary tumors in the United States

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Abstract

Purpose

Hypothalamic-pituitary axis dysfunction and mass effect symptoms in the pediatric population can indicate a pituitary region tumor. Herein, we evaluate the epidemiology and management of this rare entity.

Methods

Pediatric patients (≤ 21yo) who presented from 2004 to 2017 with a pituitary tumor were evaluated from the U.S. National Cancer Database. The distributions and management patterns of pituitary tumors were assessed by patients’ tumor type, age, sex, race/ethnicity, tumor size, and insurance status.

Results

19.7% of intracranial tumors in the pediatric population originated in the pituitary region. 7653 pediatric patients with pituitary region tumors were identified, 68.2% of whom were female, with the tumors predominantly occurring in early adolescence (46.9%) and late adolescence (34.8%). The majority of pediatric pituitary region tumors were pituitary adenomas (77.9%), followed by craniopharyngiomas (18.1%) and germ cell tumors (1.6%). Girls demonstrated higher proportions of pituitary adenomas across all ages than boys. Asian/Pacific Islander patients were independently more likely to present at younger ages (mean 13.9yrs) and with germ cell tumors than patients of other races/ethnicities. Only 5.5% of patients were uninsured (referent), but they were independently more likely to present at older ages (mean 17.9yrs) and less likely to undergo surgery than patients with private insurance (OR = 1.93, 95% CI = 1.47–2.52, p < 0.001) or Medicaid (OR = 1.51, 95% CI = 1.14–2.00, p = 0.004).

Conclusion

Pituitary region tumors comprise a significant fraction of intracranial pediatric tumors, particularly in adolescent girls. The differential diagnosis of pituitary tumor types differed significantly by patients’ age, sex, and race/ethnicity. Uninsured patients were associated with delays in care and less surgical management.

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Data availability

The NCDB PUF is available by application from the Commission on Cancer.

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Acknowledgements

JBI gratefully acknowledges funding support from the National Cancer Institute (K12CA090354) and Conquer Cancer Foundation. LEC acknowledges funding support from the National Institute of Diabetes and Digestive and Kidney (3R01DK119699-01S1). The National Cancer Data Base (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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This work received no funding support.

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Authors and Affiliations

  1. Division of Pediatric Endocrinology, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Luz E. Castellanos & Madhusmita Misra

  2. Pituitary and Neuroendocrine Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Timothy R. Smith & Edward R. Laws

  3. Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Timothy R. Smith & J. Bryan Iorgulescu

  4. Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA, USA

    J. Bryan Iorgulescu

  5. Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA

    J. Bryan Iorgulescu

Authors
  1. Luz E. Castellanos
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  2. Madhusmita Misra
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  3. Timothy R. Smith
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  4. Edward R. Laws
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  5. J. Bryan Iorgulescu
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Correspondence to J. Bryan Iorgulescu.

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This study was approved by the Mass General Brigham institutional review board.

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Castellanos, L.E., Misra, M., Smith, T.R. et al. The epidemiology and management patterns of pediatric pituitary tumors in the United States. Pituitary 24, 412–419 (2021). https://doi.org/10.1007/s11102-020-01120-5

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  • DOI: https://doi.org/10.1007/s11102-020-01120-5

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