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Growth hormone replacement therapy: is it safe to use in children with asymptomatic pituitary lesions?
Breanna L Sheldon1, Michael W O'Brien2, Matthew A Adamo2,3
1Albany Medical Center, Albany Medical College, Albany, NY, USA.
Insights
Pediatric pituitary cysts found on MRI rarely require surgery. Growth hormone replacement (GHR) is safe and does not significantly enlarge these cysts in children with growth hormone deficiency (GHD).
Area of Science:
- Pediatric Endocrinology
- Pediatric Radiology
- Pediatric Neurosurgery
Background:
- Small pituitary cysts are frequently identified in pediatric brain MRIs, especially in children diagnosed with growth hormone deficiency (GHD).
- The clinical significance and management of these incidental findings require further elucidation.
Purpose of the Study:
- To evaluate the necessity of surgical intervention for small pituitary cysts in children.
- To assess the impact of growth hormone replacement (GHR) therapy on the size of these pituitary lesions in pediatric patients.
Main Methods:
- A retrospective review was conducted on 101 pediatric patients (aged 0-19) who underwent pituitary MRI between April 2010 and November 2020.
- Data collected included patient demographics, indication for MRI, cyst volume, presence of GHD, and GHR treatment status. Follow-up MRI data were used to track cyst size changes.
Main Results:
- Of 101 children, 25 had GHD and 76 did not. GHD patients were older and had a higher proportion of males.
- Initial mean cyst volumes were comparable between GHD and non-GHD groups (0.063 cm³ vs. 0.171 cm³).
- In GHD patients receiving GHR, 10/21 cysts showed no change, 2 shrank, 7 disappeared, and 2 enlarged. No GHR recipients required surgery.
Conclusions:
- Incidental small sellar cysts in children typically do not necessitate surgical management.
- Growth hormone replacement therapy appears safe for pediatric patients with pituitary cysts and does not lead to significant cyst enlargement.
Objectives:
Small pituitary cysts are commonly discovered on pediatric brain magnetic resonance imagings (MRIs), particularly in patients with growth hormone deficiency (GHD). We examined the need for operative management in children with these masses as well as the effect of growth hormone replacement (GHR) on these lesions.
Methods:
This was a retrospective review of pituitary protocol MRIs conducted in children 0-19 at a single center between April 2010-November 2020. Sex, indication for initial MRI, volume, and whether surgery was performed was determined. Records were reviewed to determine whether GHD was present and treatment with GHR documented. For patients with subsequent MRIs, volume on most recent scan was calculated.
Results:
Of the 101 children with cysts, 25 had laboratory-confirmed GHD and 76 did not. GHD patients had a higher mean age compared to no growth hormone deficiency (NGHD) cohort (11.2 and 8.4 years, respectively; p=0.02) and a larger proportion of males (p<0.001). The mean cyst volume on initial MRI was not significantly smaller in patients with GHD (0.063 ± 0.012 cm3) vs. those without GHD (0.171 ± 0.039 cm3, p=0.11). Of the 21 GHD patients who received GHR and had follow-up MRIs, 10 had no change in pituitary cyst size, two had cysts that shrank, and seven disappeared. The remaining two cysts enlarged an average of 0.061 ± 0.033 cm3. Zero GHR recipients required surgical intervention.
Conclusions:
Small sellar cysts discovered incidentally on imaging in children are unlikely to require surgical intervention. GHR does not appear to significantly enlarge these pediatric pituitary lesions and is safe for use.
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