Endocrine Abstracts

Background: Pituitary tumors are uncommon in childhood and adolescence, with a reported prevalence of up to 1 per million children. Only 2 - 6% of surgically treated pituitary tumors occur in this age group. Although these tumors are almost never malignant and hormonal secretion is rare, they can cause significant morbidity. Pituitary microadenomas, though rare, pose unique challenges due to their potential hormonal activity and growth during a critical developmental period. Microadenomas are defined as those smaller than 10 mm, while those larger are classified as macroadenomas.

Methods - Literature Search: We conducted a search of the medical literature using Pubmed, Google Scholar, and Scopus, focusing on research articles about pituitary microadenomas in children and adolescents. A total of 33 articles met our search criteria and were analyzed for this mini review.

Results and discussion: Prevalence: Pituitary adenomas constitute about 3% of all intracranial neoplasms in children and account for 5% of all pituitary adenomas. A 60-year study on pediatric pituitary adenomas revealed a small percentage of microadenomas, underscoring their rarity.

Clinical Presentations: In a study of 20 microadenomas, 75% occurred in girls, with an average age at diagnosis of 14.4 years. Common symptoms included amenorrhea (53.3%) and galactorrhea (42.8%) in girls, and gynecomastia in boys.

Pathological types: Prolactinomas, corticotrope, and somatotroph adenomas are the most common types. Among 42 pituitary adenomas studied, 33% were macroadenomas, and 21% were microadenomas, with prolactin-secreting and ACTH-secreting adenomas being the most prevalent.

Management: Treatment strategies are guided by the tumor’s functionality and size. Medical management is typically the first choice for functioning microadenomas that secrete excess hormones. Surgical intervention, primarily transsphenoidal surgery, is reserved for symptomatic or functioning tumors unresponsive to medical therapy. Radiotherapy and radiosurgery are considered in refractory cases or when surgery and medical therapy fail.

Outcomes: The prognosis for children with pituitary microadenomas is generally favorable. For instance, in medically managed prolactinomas, many patients achieve normal prolactin levels and tumor shrinkage. Success rates for surgically treated cases vary based on tumor type and the extent of its removal.

Conclusion: Pediatric pituitary microadenomas, while rare, require a nuanced approach to diagnosis and management. Advances in diagnostic techniques and treatment protocols have improved outcomes. Ongoing research and vigilant long-term follow-up are crucial for optimizing patient care and outcomes, particularly due to the potential for recurrence and long-term endocrine effects.