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Updated: Jul 15, 2025
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Clinical and therapeutic outcomes of pediatric pituitary adenomas: a single pituitary center experience
Fatih Kilci1, Jeremy Huw Jones2, Melih Çaklılı3
1Department of Pediatric Endocrinology, School of Medicine, Kocaeli University, Kocaeli, Turkey.
Insights
Pediatric pituitary adenomas (PPAs) are rare but challenging. This study found non-functioning adenomas were most common, and hormonal issues often resolved with treatment, with low rates of new deficiencies post-surgery.
Area of Science:
- Pediatric Endocrinology
- Neuro-oncology
- Pituitary Medicine
Background:
- Pediatric pituitary adenomas (PPAs) are rare tumors, often benign but complex to manage.
- Existing research on PPAs predominantly stems from surgical case series.
- A comprehensive understanding of PPA clinical features and outcomes in a multidisciplinary setting is needed.
Purpose of the Study:
- To characterize the clinical presentation, hormonal status, and treatment outcomes of pediatric patients with pituitary adenomas.
- To evaluate the effectiveness of combined neuroendocrine and surgical management for pediatric pituitary adenomas.
- To compare findings with existing literature and identify factors influencing outcomes.
Main Methods:
- Retrospective review of demographic, clinical, and endocrinological data for patients under 19 diagnosed with PPA between 2002-2022 at a single center.
- Systematic review of 21 relevant studies published in the past two decades.
- Analysis of adenoma subtypes, presenting symptoms, hormonal deficiencies, and surgical outcomes.
Main Results:
- The cohort included 79 patients (median age 15.8 years); non-functioning adenomas (NFAs) were most frequent (35.5%), followed by prolactinomas (29.1%).
- Common symptoms included headache, visual impairment, and menstrual irregularities; central hypothyroidism was the most frequent hormonal deficiency (31.6%).
- Endoscopic endonasal transsphenoidal surgery (EETS) was performed in 63.2% of patients, with 62% experiencing recovery of endocrine function and low rates of new deficiencies (4% hypopituitarism).
Conclusions:
- This study presents one of the largest pediatric pituitary adenoma series, highlighting a higher prevalence of NFAs than previously reported.
- Appropriate endocrinological and surgical management largely resolved hormonal disorders at diagnosis, with a low incidence of post-EETS pituitary hormonal deficiencies.
- Management at high-volume pituitary centers is recommended for pediatric patients with PPA to ensure long-term outcomes and minimize morbidity.
Purpose:
Pediatric pituitary adenomas (PPA) are rare. Although PPAs are mostly benign, they can be challenging to manage. Most studies evaluating PPA are based on surgical series. We aimed to present the clinical features, hormonal status and treatment outcomes of children with PPA managed in a joint neuroendocrine setting.
Methods:
In this single-center study, demographic, clinical and endocrinological data of patients under 19 years old who were followed up with the diagnosis of PPA between 2002-2022 were retrospectively reviewed. A total of 21 studies published in the past 20 years were also systematically reviewed.
Results:
There were 79 patients (52 girls, 27 boys) with a median age of 15.8 years. Median follow-up time was 30 months. The most common adenoma subtype was non-functioning adenoma (NFA) (35.5%), followed by prolactinoma (29.1%), corticotropinoma (21.5%), and somatotropinoma (13.9%), respectively. The frequency of micro and macroadenomas was almost equal while 38% of all adenomas were invasive. Headache, visual impairment and menstrual irregularity were the most common complaints, while the most common hormonal deficiency at diagnosis was central hypothyroidism (31.6%), followed by hypogonadotropic hypogonadism (22.7%), growth hormone deficiency (15.2%) and central adrenal insufficiency (11.4%), respectively. Fifty patients (63.2%) underwent endoscopic endonasal transsphenoidal surgery (EETS). Following the surgery, impaired endocrine functions recovered at a rate of 62% while permanent central diabetes insipidus was observed in 6%, and new onset hypopituitarism developed in 4%.
Conclusion:
NFA was more common in this cohort than in previous reports, which is one of the largest PPA series in the literature. Hormonal disorders, which were common at the time of diagnosis, were largely resolved with appropriate endocrinological and surgical approaches, while the rate of pituitary hormonal deficiencies after EETS was relatively low. Therefore, we recommend that children with PPA be managed in the setting of a high-volume pituitary center to provide long-term low morbidity.
