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Non-functioning pituitary microadenoma in children and adolescents: Is follow-up with diagnostic imaging necessary?
Camilla Borghammar1, Ashkan Tamaddon2, Eva-Marie Erfurth3
1Skåne University Hospital, Department of Clinical Sciences, Pediatrics, Pediatric Endocrinology, Lund University, Lund, Sweden. camilla.borghammar@med.lu.se.
Insights
Pediatric pituitary microadenomas without hormonal issues show minimal growth. New guidelines suggest tailored follow-up imaging based on lesion size to avoid unnecessary magnetic resonance imaging (MRI) scans.
Area of Science:
- Pediatric Endocrinology
- Neuroradiology
- Oncology
Background:
- No established follow-up guidelines exist for pediatric pituitary microadenomas.
- Accurate assessment of lesion growth potential is crucial for appropriate management.
Purpose of the Study:
- To investigate the growth potential of pituitary solid and cystic lesions under 10 mm in children.
- To evaluate the accuracy of magnetic resonance imaging (MRI) measurements for these lesions.
Main Methods:
- Retrospective analysis of 74 children (<18 years) with non-functioning pituitary microadenomas or cysts (<10 mm).
- Re-evaluation of lesion size across all MRI examinations with a median follow-up of 37 months.
- Assessment of inter-reader agreement for lesion identification and location, and measurement variability.
Main Results:
- None of the pituitary lesions without hormonal disturbances showed significant growth during follow-up.
- Radiologists disagreed on lesion identification in 14% and location in 22% of MRI examinations.
- Size differences >2 mm, considered significant progression, occurred in only 7% of measurements.
Conclusions:
- Non-functioning pituitary microadenomas in children exhibit minor size variations, often within the limits of MRI spatial resolution.
- Proposed follow-up recommendations: clinical follow-up for lesions <4 mm; MRI at 2 years for 4-6 mm lesions; MRI at 1 and 3 years for ≥7 mm lesions.
- Further MRI is recommended only for new clinical symptoms or hormonal disturbances, indicating no progression.
Purpose:
No consensus exists regarding follow-up recommendations for suspected pituitary microadenoma in children. To address this knowledge gap, we investigated the growth potential of pituitary solid and cystic lesions <10 mm in children and evaluated the accuracy of magnetic resonance imaging (MRI) measurements.
Methods:
The children included were <18 years at first pituitary MRI and radiologically diagnosed with a non-functioning microadenoma or cyst <10 mm. Lesion size at first and latest MRI as well as all individual MRI examinations were re-evaluated.
Results:
In total, 74 children, median age 12 years (range 3-17), had a non-functioning microadenoma, probable microadenoma, or cyst. Of these, 55 underwent repeated MRI (median 3, range 2-7) with a median follow-up of 37 months (range 4-189). None of the pituitary lesions without hormonal disturbances increased significantly during follow-up. Two radiologists agreed that no lesion could be identified in 38/269 (14%) MRI examinations, and in 51/231 (22%) they disagreed about lesion location. In 34/460 (7%) MRI measurements size differed >2 mm, which had been considered significant progression.
Conclusion:
Non-functioning pituitary microadenoma in children has small size variations, often below the spatial resolution of the scanners. We suggest lesions <4 mm only for clinical follow-up, lesions 4-6 mm for MRI after 2 years and ≥7 mm MRI after 1 and 3 years, with clinical follow-up in between. If no progression, further MRI should only be performed after new clinical symptoms or hormonal disturbances.
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