Pediatric pituitary microadenomas: a case series and review of diagnostic challenges and treatment outcomes

Ashraf Soliman; Noor Hamed; Nada Alaaraj; Fawzia Alyafei; Shayma Ahmed

doi:10.1530/endoabs.99.EP1193

Background: Pituitary microadenomas in pediatric populations, though infrequent, present diagnostic and therapeutic challenges.

Methods: We retrospectively reviewed six pediatric cases of pituitary microadenomas diagnosed and treated at our institution. The cases were analyzed for presenting symptoms, hormonal profiles, and treatment responses.

Results: Case 1: A 12-year-old with growth hormone deficiency showed significant height improvement with somatropin treatment, without change in microadenoma size. Case 2: Central hypothyroidism was managed with levothyroxine, resulting in the resolution of headaches and fatigue, though growth deceleration persisted. Case 3: Precocious puberty was treated with a GnRH analogue, with ongoing monitoring. Case 4: The patient awaits further evaluation for recurrent headaches and elevated IGF1. Case 5: Early puberty signs were managed with triptorelin, with ongoing monitoring for microadenoma. Case 6: Treatment for precocious puberty and GH hypersecretion involved a GnRH analogue, with abnormal growth patterns under investigation.


Case	Age at Presentation	Presenting Complaints	Main Findings	Hormonal Abnormalities	Treatment/Follow-up
1	12 years	Short stature	WtSDS=-2.22, HtSDS=-2.6, GV=4 cm/year, MPHSDS=-1.28, IGF1 SDS=-1.81, GH peak 5.2 mg/l	GH deficiency	Started somatropin, no significant change in microadenoma size
2	12.4 years	Headaches and fatigability	HtSDS=-0.5, MPHSDS=0, GV=2.6 cm/year, IGF1 SDS=-1.28, GH peak 6.7 mg/l, low FT4, advanced bone age	Central hypothyroidism, GH deficiency	Started on levothyroxine, slow GV, continued levothyroxine after stopping
3	7 years 10 months	Premature thelarche, accelerated growth, premature pubarche	GV=12.2 cm/year, HtSDS=+1.72, MPHSDS=-0.82, advanced bone age, high basal LH and FSH	Central precocious puberty	Started on GnRH analogue, will be reevaluated
4	12 years	Recurrent headaches, secondary amenorrhea	BMISDS=2.5, HtSDS=+0.8, GV=2.2 cm/year, high morning ACTH, normal cortisol, prolactin, LH and FSH	ACTH hypersecretion, central precocious puberty	Planned for GH suppression test, pelvic US, and salivary cortisol
5	2.8 years	Premature thelarche, family concern about accelerated growth	HtSDS=2.4, BMISD=0.44, high basal and stimulated LH and FSH, high estradiol, IGF1SDS=+3.1	Central precocious puberty	Started on triptorelin, will be followed for growth and MRI
6	7 years 5 months	Excessive body hair, symptoms of precocious puberty	Advanced bone age, high IGF1, paradoxical increase in GH during suppression test	Central precocious puberty GH and ACTH hypersecretion	Treatment with GnRH analogue, reassessment indicated abnormal growth

Conclusions: The six cases exhibited a spectrum of growth anomalies ranging from short stature with slow growth velocity to precocious puberty with accelerated growth. Hormonal disturbances included growth hormone deficiency, central hypothyroidism, and central precocious puberty.

Endocrine Abstracts

EP1193