Endocrine Abstracts

Introduction: Clinically non-secreting pituitary adenomas are rare in children We report a case of a silent somatotropic adenoma revealed by anatomopathology.

Case: A 13 year-old patient with no prior history of sudden onset intracranial hypertension syndrome. Clinical examination showed no dysmorphic Syndrome, no galactorrhea, no delay or statutory advance, Tanner P1S3. The MRI reveals a heterogeneous tumor process intra and suprasellar of 30 mm *15 mm of large axes, containing pockets of necrosis exerting a mass effect on neighboring structures and in particular on the optic nerves and quiasma evoking a priori craniopharyngioma. Initial hormonal balance: T4: 17,1 pmol/l;Cortisol:8,85 g/dl Prolactina:10,25 ng/ml, FSH: 2,2 UI/l; LH:0,1 UI/l; Eostradiol:8,2 ng/l and visual fields bitemporal hemianopsia. Partial transsphenoidal pituitary surgery performed in emergency with simple surgical follow-up and supplemented thyreocorticotropic deficit. The anatomopatho-immunohistochimical study concludes to a tumor proliferation with round cells whose morphological aspect first evokes pituitary adenoma secreting GH with Ki67 to1%. Before this and the normal initial IGF-1 at 360.1 ng/ml (90-581) a GH braking test under HGPO is performed with a GHnadir at 2.03 ng/ml confirming hypersecretion ofGH. Patient scheduled for surgery.

Discussion: Pituitary adenomas are rare tumors in children and adolescents whose most common type is prolactinoma followed by somatotropic as our case. The clinical expression of somatotropic adenoma is correlated with the early age of GH hypersecretion in relation to the welding or not of the epiphyses giving way to acromegalogigantism or gigantism. None of these dysmorphia have been found in our case thus signing the silent character of this somatotropic. The initial hormonal balance doesn’t direct to any pituitary hypersecretion especially with a normal IGF-1 for age. Our presentation by ICHT syndrome, radiological elements as well as age were all in favor of craniopharyngioma which remains the most common tumor at this age. Only anatomopathological examination with positive immuno-labeling for GH supplemented by a GH braking test under HGPO initially not performed allowed to retain the diagnosis. The treatment is surgery with possible treatment by somatostatin analogous in case of no cure hence the surgical resumption planned for our case.

Conclusion: Before any sellar tumour any clinico-radiological presentation in children the anatomopathological study is the sole guarantaor of specific treatment.

References: 1-Abe T, et al. Clinicallynonsecreting pituitary adenomas in childhood and adolescence. Neurosurgery. 1998 Apr;42(4):744-50

2-Chanson P, Salenave S. Diagnosis and treatment of pituitaryadenomas. Minerva Endocrinol. 2004 Dec;29(4):241-75.