Pituitary adenomas in childhood and adolescence. Clinical analysis of 10 cases

Pituitary adenomas in childhood and adolescence constitute 2-6% of all oper ated pituitary adenomas. We report the clinical features, treatment and fol low-up of 10 pediatric patients affected by pituitary adenomas. All patient s underwent clinical evaluation, endocrine tests, magnetic resonance imagin g and visual field assessment. Follow-up ranged from 8 to 132 months (media n 52.6). All patients were older than 10 years of age; 60% were males. In 5 0% the initial complaints were headache and/or visual impairment, all excep t one had clear evidence of endocrine dysfunction. Ninety percent were macr oadenomas. According to hormone measurements and immunostaining 50% were pr olactinomas, 20% were pure GH-secrating and 30% were non-functioning adenom as. Prolactinomas in two females were successfully treated with cabergoline . The other patients underwent surgery: three prolactinomas are still being treated with dopamine agonists and a GH-secreting adenoma is being treated with octreotide LAR and cabergoline. Two patients were also treated with c onventional radiotherapy. Treatments were completely successful in 50% of p atients: these have normal hormone secretion, full pubertal development, no significant tumor mass and normal visual field. Hypersecretion of prolacti n persists in two cases; partial or complete hypopituitarism is present in four, relevant tumor remnant in another four and impairment of visual field is present in two cases. In conclusion, pediatric adenomas occur mostly in pubertal age, are prevalently macroadenomas and clinically functioning. Me dical therapy should be preferred for secreting adenomas, but in some cases , notably prolactinomas in males, surgery and eventual radiotherapy may be needed. (C)2001, Editrice Kurtis.