Can pediatric patients develop pituitary adenoma?

From the Guidelines

Yes, young children can develop pituitary adenomas, though they are relatively rare in this age group. Pituitary adenomas are benign tumors that develop in the pituitary gland and are more commonly diagnosed in adults. When they occur in children, they often present with symptoms related to hormone overproduction or deficiency, including growth abnormalities, delayed or precocious puberty, headaches, and visual disturbances 1. Diagnosis typically involves blood tests to measure hormone levels, as well as imaging studies such as MRI to visualize the tumor.

Key Considerations

• The incidence of pituitary adenomas increases with age, with 78% of pituitary fossa lesions in children and young people under 19 years of age being pituitary adenomas 1.
• Children with pituitary adenomas often have a more aggressive disease and increased potential for familial or genetic etiology compared to adults 1.
• Treatment approaches for pediatric pituitary adenomas include medication, surgery, and occasionally radiation therapy for resistant cases.
• The specific treatment depends on the tumor type, size, and hormonal activity, and children with pituitary adenomas require long-term follow-up with pediatric endocrinologists to monitor hormone levels, growth, and development 1.

Genetic Considerations

• Genetic assessment is recommended for all children with pituitary adenomas to inform management and family surveillance, particularly for those with growth hormone and prolactin excess 1.
• Genetic testing can identify germline and somatic genetic alterations, which can inform prognosis, treatment, and screening for other manifestations in the proband and family members 1.
• Children with pituitary adenomas due to genetic causes may require more treatment modalities compared to those without genetic etiology 1.

Treatment Approaches

• Medication, such as cabergoline for prolactinomas, starting at low doses of 0.25-0.5 mg twice weekly, may be used to treat pediatric pituitary adenomas.
• Surgery, typically via a transsphenoidal approach, may be necessary for some cases.
• Radiation therapy may be used for resistant cases.
• Long-term follow-up with pediatric endocrinologists is essential to monitor hormone levels, growth, and development in children with pituitary adenomas.

From the Research

Pituitary Adenoma in Young Children

• Pituitary adenomas are considered rare tumors in the pediatric age group 2, 3, 4, 5, 6
• The natural history of pituitary adenomas in children is not well known 2
• Studies have shown that pituitary adenomas in children can be extrasellar and invasive, but this is not always the case 2, 6
• The majority of pituitary adenomas in children are secreting functional tumors with the potential for physiological sequelae that can affect a child's development 3

Age and Sex Distribution

• Pituitary adenomas are more frequent in adolescents than in children 4
• The female-to-male ratio of pituitary adenomas in children and adolescents is approximately 1.8:1 4
• The youngest patient reported with a pituitary adenoma was 6 years old 5, and 8 years old 4

Clinical Presentation and Management

• Common symptoms of pituitary adenomas in children include headaches, visual disturbances, and hormonal imbalances 5, 6
• Transsphenoidal surgery is a common and effective treatment for pituitary adenomas in children 2, 5
• A multidisciplinary team of surgeons, endocrinologists, and neuroanesthesiologists is required for the management of pituitary tumors in children 3
• Adenomas with an elevated proliferation index or evidence of local invasion may have a higher recurrence rate 4