Pituitary adenomas in childhood, adolescence and young adulthood: presentation, management, endocrine and metabolic outcomes.
OBJECTIVE
To elucidate the long-term outcomes of pituitary adenomas diagnosed in childhood and adolescence, knowledge of which remains sparse.


METHODS
A retrospective review of patients aged ≤21 years at diagnosis of pituitary adenoma, attending a neuroendocrine service in Liverpool, UK, between 1984-2009.


RESULTS
There were 41 patients (33 female), mean age at diagnosis 17.3 years (range 11-21) and mean follow-up 9.6 years; 29 patients had prolactinomas (15 macroprolactinomas), 6 non-functioning pituitary adenomas (NFPAs), 5 Cushing's disease (CD) and 1 acromegaly. All prolactinoma patients received dopamine agonists (DAs) and three also underwent pituitary surgery. Furthermore, ten patients underwent surgery: five with CD, one with acromegaly and four with NFPA. Four received radiotherapy after surgery. Another ten patients received hormone replacement: nine hydrocortisone, five thyroxine, seven sex steroids and five GH; another seven had severe asymptomatic GH deficiency. Three female patients were treated for infertility (two successfully). Thirteen patients gained significant weight (body mass index (BMI) increase >2 kg/m(2)) since diagnosis and 16 in total are now obese (BMI>30 kg/m(2)). Five were treated with orlistat and one attended a weight management service. Two received antihypertensive medications, two had type 2 diabetes and four were treated for dyslipidaemia.


CONCLUSIONS
This is one of the largest reviews of patients aged 21 or younger at diagnosis of pituitary adenoma followed up by a single service. Two-thirds had prolactinomas, all were treated with DAs and three underwent surgery. Increased cardiovascular risk factors (obesity and dyslipidaemia) and infertility are important sequelae and active identification and treatment are necessary.
Steele
Caroline A
CA
Diabetes and Endocrinology Clinical Research Group, Department of Endocrinology and Diabetes, Clinical Sciences Centre, Aintree University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, UK. c.a.steele@liverpool.ac.uk
MacFarlane
Ian A
IA
Blair
Joanne
J
Cuthbertson
Daniel J
DJ
Didi
Mohammed
M
Mallucci
Conor
C
Javadpour
Mohsen
M
Daousi
Christina
C
D000293:Adolescent; D000328:Adult; D002648:Child; D018491:Dopamine Agonists / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000188:drug therapy / Q000209:etiology / Q000532:radiotherapy / Q000601:surgery; D010911:Pituitary Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000532:radiotherapy / Q000601:surgery; D015175:Prolactinoma / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
D018491:Dopamine Agonists