Pituitary incidentalomas in paediatric age are different from those described in adulthood
- 35 Downloads
Guidelines on pituitary incidentalomas evaluation and management are limited to adults since there are no data on this matter in the paediatric population. We aim to analyse the morphologic characteristics, hormonal profile and follow-up of these lesions in children.
We have searched for pituitary incidentalomas in the neuroimaging reports and electronic medical records of the Paediatric Endocrinology Clinic of our centre. Patients with 18 years-old or less were included.
Forty-one incidentalomas were identified, 25 of them (62.4%) in females. The mean age at diagnosis was 12.0 ± 4.96 years-old. Headaches were the main reason that led to image acquisition (51.2%) and MRI was the imaging method that detected the majority of the incidentalomas (70.7%). The most prevalent lesion was pituitary hypertrophy (29.3%), which was mainly diagnosed in female adolescents (91.7%), followed by arachnoid cysts (17.1%), pituitary adenomas (14.6%) and Rathke’s cleft cysts (12.2%). Most patients (90.2%) did not present clinical or laboratorial findings of hypopituitarism or hormonal hypersecretion. Four patients presented endocrine dysfunction: three had growth hormone deficiency and one had a central precocious puberty. Twenty-three patients (56.1%) underwent imagiological revaluation during a median follow-up time of 24.6 months (interquartile range 5.07). None of them presented dimensional progression.
To the best of our knowledge, this is the first series of pituitary incidentalomas in pediatric age. Comparing our series with those conducted in adults, we have observed a higher preponderance of pituitary hypertrophy over adenomas, a lower prevalence of hormonal hyper/hyposecretion and lower risk of dimensional progression during follow-up.
KeywordsPituitary gland Incidentaloma Pediatrics Neuroimaging
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
Human and animal rights
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 3.Molitch ME (2009) Pituitary tumours: pituitary incidentalomas. Best practice & research. Clin Endocrinol Metab 23(5):667–675Google Scholar
- 7.Goldberg AS, Stein R, Merritt NH, Inculet R, Van Uum S (2014) A pediatric patient with Cushing syndrome caused by ectopic ACTH syndrome and concomitant pituitary incidentalomas. J Pediatr Endocrinol Metab 27(1–2):123–128Google Scholar
- 10.Kruis RWJ, Schouten-van Meeteren AYN, Finken MJJ, Oostdijk W, van Trotsenburg ASP, Boot AM, Claahsen-van der Grinten HL, van Lindert EJ, Han KS, Hoving EW, Michiels EMC, van Santen HM (2018) Management and consequences of postoperative fluctuations in plasma sodium concentration after pediatric brain tumor surgery in the sellar region: a national cohort analysis. Pituitary 21(4):384–392CrossRefGoogle Scholar
- 13.Barkovich A, Raybaud C (2012) Pediatric neuroimaging, 5th ed. Wolters Kluwer, PhiladelphiaGoogle Scholar
- 14.Osborn A, Hedlung G, Salzman K (2017) Osborn’s brain: imaging, pathology, and anatomy, 2nd edn. Elsevier, Salt Lake CityGoogle Scholar
- 22.Tsunoda A, Okuda O, Sato K (1997) MR height of the pituitary gland as a function of age and sex: especially physiological hypertrophy in adolescence and in climacterium. Am J Neuroradiol 18(3):551–554Google Scholar
- 26.Fernandez-Balsells MM, Murad MH, Barwise A, Gallegos-Orozco JF, Paul A, Lane MA, Lampropulos JF, Natividad I, Perestelo-Perez L, de Leon-Lovaton PG, Erwin PJ (2011) Natural history of nonfunctioning pituitary adenomas and incidentalomas: a systematic review and metaanalysis. J Clin Endocrinol Metab 96(4):905–912CrossRefGoogle Scholar
- 27.Rousseau-Nepton I, Kaduri S, Garfield N, Krishnamoorthy P (2014) Hypothalamic hamartoma associated with central precocious puberty and growth hormone deficiency. J Pediatr Endocrinol Metab 27(1–2):117–121Google Scholar
- 28.Martin DD, Seeger U, Ranke MB, Grodd W (2003) MR imaging and spectroscopy of a tuber cinereum hamartoma in a patient with growth hormone deficiency and hypogonadotropic hypogonadism. Am J Neuroradiol 24(6):1177–1180Google Scholar