TRANSSPHENOIDAL SURGERY FOR PITUITARY-ADENOMAS IN CHILDREN

THE AUTHORS HAVE reviewed the results of transsphenoidal surgery for p ituitary adenomas done on 66 children (younger than 16 yr of age) betw een 1966 and 1992. Ninety-four percent (62 of 66) showed clinical evid ence of pituitary hormonal hypersecretion. The most common type was th e adrenocorticotropic hormone-secreting adenoma (n = 36), followed by the prolactinoma (n = 18) and the growth hormone-secreting types (n = 8). There were four cases of nonfunctioning adenomas. Adrenocorticotro pic hormone-secreting tumors in children had presentations and surgica l results similar to those seen in adults. Twenty-three of 33 patients with Cushing's disease had simple adenomectomy or subtotal hypophysec tomy without symptomatic recurrence. Four of 10 initial treatment fail ures had subsequent successful surgical intervention, resulting in an overall cure rate of 78%. Postoperative hypocortisolism was suggestive of surgical success but was not absolute. Of three patients with Nels on syndrome, none were successfully treated with surgery alone and two developed invasive disease. Prolactin-secreting and growth hormone-se creting tumors in children occurred more commonly with suprasellar exp ansion than did their adult counterparts. Transsphenoidal surgery was capable of controlling disease in only 12% (1 of 8) of growth hormone- secreting tumors, and 67% (12 of 18) of prolactin-secreting tumors req uired postoperative medical therapy or radiotherapy for persistently e levated prolactin levels. Special difficulty was noted in boys with pr olactinomas and in girls with primary amenorrhea. As in adults, preope rative prolactin levels correlated with ultimate surgical success rate s. Seventeen percent of patients (12 of 66) required drilling of incom pletely pneumatized sphenoid sinuses, but in no cases were anatomic di fferences related to patient age or size thought to be a limiting fact or in the surgical procedure and outcome.