Endocrine Abstracts

Introduction: Pituitary adenomas are uncommon in childhood and adolescence and knowledge of long-term outcomes is sparse. We describe a large cohort of patients, now attending our adult clinic.

Patients and methods: Retrospective review of patients aged ≤18 years at diagnosis of a pituitary adenoma.

Results: There were 24 patients (18 female), mean age at diagnosis 15.6 (range 11–18) years, current age 25.5 (14–47). Of 14 were prolactinomas (10 macroprolactinomas), 3 non-functioning adenomas (2 macroadenomas), 5 Cushing’s disease, 1 pituitary cyst and 1 pituitary apoplexy. Of the 14 prolactinomas (all female, mean age at diagnosis 16.3 years, mean prolactin at diagnosis 12 258 (1276–60 000) mU/l), all received dopamine agonists (DA); 2 required surgery because of worsening visual field defects. One presented with short stature and delayed puberty; 5 had galactorrhoea; 12 oligo-/amenorrhoea. Current age 25.1 (16–37), mean prolactin on DA 1083 (2–5527) mU/l. Three patients have conceived spontaneously, two have been treated for infertility. Mean body mass index (BMI) at diagnosis 27.6 kg/m² (SDS 1.1), current BMI 34.4. Five patients with Cushing’s disease underwent surgery; two relapsed and required further surgery and one radiotherapy. Of the 24 patients, the majority receive endocrine replacement (11 GH). BMI increased from 26.4 (at diagnosis) to 30.2 at latest follow-up, excluding Cushing’s patients. Mean cholesterol 5.5 (3.2–8) mmol/l, one treated with a statin, one has hypertension and 2 receive orlistat.

Conclusions: This is one of the largest single centre reviews of patients aged 18 or younger when diagnosed with a pituitary tumour. Nearly 60% were prolactinomas, all occurring in females. All were treated with DA but two required surgery. Non-functioning adenomas and Cushing’s are less common with no acromegaly. Increased cardiovascular risk factors (obesity and dyslipidaemia) and infertility are frequent sequelae and their active treatment is important.