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Published on: January 17, 2018
Pediatric Pituitary Adenomas and Cysts: A 46-Year Population-Based Analysis
Kaitlin Leopold1, Mostafa Salama1, Seema Kumar1
1Division of Pediatric Endocrinology and Metabolism, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Insights
Pediatric pituitary adenomas and cysts are rare, with most being small and nonfunctioning. These lesions are typically stable over time, requiring further study for long-term management strategies.
Area of Science:
- Pediatric Endocrinology
- Neuro-oncology
- Epidemiology
Background:
- Pituitary adenomas and cysts are uncommon in children, necessitating a better understanding for effective management.
- Improved knowledge of pediatric pituitary lesions can inform clinical practice guidelines.
Purpose of the Study:
- To determine the incidence, clinical presentation, management, and outcomes of pituitary adenomas and cysts in a pediatric population.
- To investigate correlations between lesion characteristics (size, headaches) and disease progression, and MRI rates.
Main Methods:
- Retrospective cohort study of pediatric patients (≤18 years) with pituitary adenomas/cysts in Olmsted County, MN (1976-2021).
- Utilized Rochester Epidemiology Project diagnostic codes to identify 37 confirmed cases from 234 unique patients.
- Calculated incidence rates and analyzed clinical data using descriptive statistics.
Main Results:
- Incidence was 2.29 cases per 100,000 person-years.
- Most common types were nonfunctioning (68%) and prolactinomas (27%); GH- and TSH-secreting adenomas were rare.
- Median lesion size was 5.5 mm; median follow-up was 7.4 years. Disease progression occurred in 4 patients, stabilizing with treatment. No significant correlation found between MRI rates, lesion size, or headaches and disease progression.
Conclusions:
- Pediatric pituitary adenomas and cysts are rare, often small, nonfunctioning, and demonstrate stability during long-term follow-up.
- Further large-scale studies are required to elucidate the natural history of small, nonfunctioning pituitary lesions and refine management recommendations.
Context:
Pituitary adenomas and cysts are rare in pediatric patients and improved understanding can guide management recommendations.
Objective:
To report incidence, presentation, management, and outcomes in a pediatric population-based cohort with pituitary adenomas and cysts, and to explore the relationship between these lesions and brain magnetic resonance imaging (MRI) rates, as well as lesion size and headaches with disease progression.
Methods:
In this retrospective cohort study of pediatric patients (≤18 years) with incident pituitary adenomas and cysts in Olmsted County, MN, from 1976 to 2021, 234 unique patients were identified using diagnostic codes through the Rochester Epidemiology Project, with 37 confirmed cases of pituitary adenoma or cyst included. Incidence rates were calculated using census data. Descriptive statistics were used for extracted clinical data.
Results:
Incidence of pediatric adenomas and cysts was 2.29 cases per 100 000 person-years. Of the 37 cases, 68% were nonfunctioning adenomas or cysts, 27% were prolactinomas, and there was 1 each of growth hormone (GH)- and thyrotropin (TSH)-secreting adenomas. Median lesion diameter was 5.5 mm (IQR, 4.0-8.0). Median follow-up was 7.4 years (IQR, 4.5-15.4). Four patients had disease progression which stabilized with second-line therapy. Brain MRI rates did not correlate with lesion incidence. No clinically meaningful relationship was found between lesion size or headache and disease progression.
Conclusion:
Pituitary adenomas and cysts are rare in pediatric patients. Most are small, nonfunctioning, and stable on long-term follow-up. Larger studies on small nonfunctioning pituitary lesions are needed to enhance understanding of their natural history and develop long-term management recommendations.
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