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Clinical and therapeutic outcomes of pediatric pituitary adenomas: a single pituitary center experience

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Abstract

Purpose

Pediatric pituitary adenomas (PPA) are rare. Although PPAs are mostly benign, they can be challenging to manage. Most studies evaluating PPA are based on surgical series. We aimed to present the clinical features, hormonal status and treatment outcomes of children with PPA managed in a joint neuroendocrine setting.

Methods

In this single-center study, demographic, clinical and endocrinological data of patients under 19 years old who were followed up with the diagnosis of PPA between 2002-2022 were retrospectively reviewed. A total of 21 studies published in the past 20 years were also systematically reviewed.

Results

There were 79 patients (52 girls, 27 boys) with a median age of 15.8 years. Median follow-up time was 30 months. The most common adenoma subtype was non-functioning adenoma (NFA) (35.5%), followed by prolactinoma (29.1%), corticotropinoma (21.5%), and somatotropinoma (13.9%), respectively. The frequency of micro and macroadenomas was almost equal while 38% of all adenomas were invasive. Headache, visual impairment and menstrual irregularity were the most common complaints, while the most common hormonal deficiency at diagnosis was central hypothyroidism (31.6%), followed by hypogonadotropic hypogonadism (22.7%), growth hormone deficiency (15.2%) and central adrenal insufficiency (11.4%), respectively. Fifty patients (63.2%) underwent endoscopic endonasal transsphenoidal surgery (EETS). Following the surgery, impaired endocrine functions recovered at a rate of 62% while permanent central diabetes insipidus was observed in 6%, and new onset hypopituitarism developed in 4%.

Conclusion

NFA was more common in this cohort than in previous reports, which is one of the largest PPA series in the literature. Hormonal disorders, which were common at the time of diagnosis, were largely resolved with appropriate endocrinological and surgical approaches, while the rate of pituitary hormonal deficiencies after EETS was relatively low. Therefore, we recommend that children with PPA be managed in the setting of a high-volume pituitary center to provide long-term low morbidity.

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Authors and Affiliations

  1. Department of Pediatric Endocrinology, School of Medicine, Kocaeli University, Kocaeli, Turkey

    Fatih Kilci & Filiz Mine Çizmecioğlu-Jones

  2. Department of Academic Writing, Kocaeli University, Kocaeli, Turkey

    Jeremy Huw Jones

  3. Department of Neurosurgery and Pituitary Research Center, School of Medicine, Kocaeli University, Kocaeli, Turkey

    Melih Çaklılı & Savaş Ceylan

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  1. Fatih Kilci
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Contributions

F.K.: data collection, formal analysis, investigation, methodology, validation, visualization, writing. J.H.J.: formal analysis, investigation, methodology, validation, and writing – review & editing. M.C.: data collection, formal analysis, investigation, validation. SC: methodology, validation, writing-review & editing, and formal analysis. F.M.C.J.: data collection, formal analysis, investigation, methodology, validation, and writing – review & editing. All the authors gave their final approval of the article.

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Correspondence to Filiz Mine Çizmecioğlu-Jones.

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The authors declare no competing interests.

Ethical approval

This study was conducted by the Department of Pediatric Endocrinology and the Department of Neurosurgery at a tertiary referral pituitary center. This study was performed in line with the principles of the Declaration of Helsinki. Written informed consent was obtained from the parents. The study protocol was approved by the Kocaeli University Medical School Ethics Committee (approval number: 2021/24).

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Kilci, F., Jones, J.H., Çaklılı, M. et al. Clinical and therapeutic outcomes of pediatric pituitary adenomas: a single pituitary center experience. Endocrine 83, 160–170 (2024). https://doi.org/10.1007/s12020-023-03523-3

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