Hypothalamic-pituitary lesions in pediatric patients: endocrine symptoms often precede neuro-ophthalmic presenting symptoms.
OBJECTIVE
To evaluate whether analyses of clinical and endocrine presenting symptoms could help to shorten the time to diagnosis of hypothalamic-pituitary lesions in children.


METHODS
A retrospective, single-center, cohort study of 176 patients (93 boys), aged 6 years (range, 0.2-18 years), with hypothalamic-pituitary lesions was performed.


RESULTS
The lesions were craniopharyngioma (n = 56), optic pathway glioma (n = 54), suprasellar arachnoid cyst (n = 25), hamartoma (n = 22), germ cell tumor (n = 12), and hypothalamic-pituitary astrocytoma (n = 7). The most common presenting symptoms were neurologic (50%) and/or visual complaints (38%), followed by solitary endocrine symptoms (28%). Precocious puberty led to diagnosis in 19% of prepubertal patients (n = 131), occurring earlier in patients with hamartoma than in patients with optic-pathway glioma (P < .02). Isolated diabetes insipidus led to diagnosis for all germ-cell tumors. For 122 patients with neuro-ophthalmic presenting symptoms, the mean symptom interval was 0.5 year (95% CI, 0.4-0.6 year), although 66% of patients had abnormal body mass index or growth velocity, which preceded the presenting symptom interval onset by 1.9 years (95% CI, 1.5-2.4 years) (P < .0001) and 1.4 years (95% CI, 1-1.8 years) (P < .0001), respectively. Among them, 41 patients were obese before diagnosis (median 2.2 years [IQR, 1-3 years] prior to diagnosis) and 35 of them had normal growth velocity at the onset of obesity. The sensitivity of current guidelines for management of childhood obesity failed to identify 61%-85% of obese children with an underlying hypothalamic-pituitary lesion in our series.


CONCLUSIONS
Endocrine disorders occurred in two-thirds of patients prior to the onset of the neuro-ophthalmic presenting symptom but were missed. Identifying them may help to diagnose hypothalamic-pituitary lesions earlier.
Université Paris Descartes and Assistance Publique-Hopitaux de Paris, Hôpital Bicêtre, Unité d'Endocrinologie Pédiatrique, Le Kremlin Bicêtre, France. melissa.taylormarchetti@gmail.com
Melissa
M
Taylor
Ana-Claudia
AC
Couto-Silva
Luis
L
Adan
Christine
C
Trivin
Christian
C
Sainte-Rose
Michel
M
Zerah
Dominique
D
Valteau-Couanet
François
F
Doz
Martin
M
Chalumeau
Raja
R
Brauner
D000293:Adolescent; D001932:Brain Neoplasms / Q000150:complications / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004700:Endocrine System Diseases / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005910:Glioma / Q000150:complications / Q000175:diagnosis; D006801:Humans; D007029:Hypothalamic Neoplasms / Q000150:complications / Q000175:diagnosis; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology*; D007031:Hypothalamus / Q000473:pathology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010372:Pediatrics / Q000379:methods; D010902:Pituitary Gland / Q000473:pathology; D010911:Pituitary Neoplasms / Q000150:complications / Q000175:diagnosis; D012189:Retrospective Studies; D013997:Time Factors; D014786:Vision Disorders / Q000150:complications / Q000175:diagnosis