Natural history of pituitary incidentalomas in pediatric patients: a single-center, retrospective analysis

With increased use of advanced imaging techniques, pediatric pituitary incidentalomas are more frequently identified. There is limited data and sparse clinical practice guidelines about prognosis and management of pediatric patients with nonfunctioning pituitary abnormalities.

The aim of this study is to provide information about clinical features and clinical course of pediatric patients who had incidental pituitary lesions identified on magnetic resonance imaging (MRI) and to identify characteristics that may portend development of endocrinopathy or neurologic symptoms.

This retrospective observational study reviewing 24 years of patients at a single tertiary care academic children's hospital included pediatric patients with a pituitary incidentaloma identified on MRI with no predisposing factors to developing brain lesions. Electronic health records were queried to identify patients with MRI imaging of brain and pituitary lesions who were evaluated by neurosurgery and/or endocrinology. Patient characteristics, clinical course, and serial imaging studies were reviewed for patients found to have pituitary incidentaloma.

A total of 35 patients with pituitary incidentalomas were identified. Among them, 25 lesions were microincidentalomas (<10 mm); 4 of these enlarged to become macroincidentalomas (≥10 mm). Overall, 27 lesions were cystic. Headache (51%) was the most common reason for initial imaging. No patient developed an endocrinopathy or new neurological symptoms over a median follow-up period of 23 months.

Pediatric pituitary incidentalomas are generally benign. Patients did not develop endocrinopathies or neurological symptoms. In the absence of new symptoms, monitoring clinically rather than with recurrent imaging or lab evaluation may be warranted.