Pediatric giant pituitary adenomas: are they different from adults? A clinical analysis of a series of 12 patients.
OBJECTIVE
To evaluate clinical presentation and microsurgical outcome of giant pituitary adenomas (GPAs) in pediatric age.


METHODS
All patients <18 years, who were operated on at our center for GPA (tumor >40 mm in maximum diameter) were included in study. Clinical features, hormonal profile, radiology, surgical approach, results and complications were analysed.


RESULTS
A total of 12 children with GPA were managed microsurgically. Visual deterioration (73 %) was most common presentation. Functioning adenomas were found in 83 % patients, with prolactinomas being most common. Twelve patients underwent a total of 16 microsurgical procedures, with a single surgery done in eight (75 %) patients. Out of the 12 primary surgeries, eight (67 %) were performed trans-sphenoidally. A near-total excision (>90 % tumor removal) could be achieved in six (50 %) patients. Visual improvement was observed in 44 % patients. However, there was no improvement in those where the eye was negative to perception of light prior to surgery. At the last follow-up, all the patients with functioning adenomas were in hormonal remission, and there was no residual/recurrent tumor in patients with non-functional adenomas. 25 % experienced single or multiple perioperative or postoperative complications. There was one perioperative death (8 %).


CONCLUSIONS
GPAs are very rare in the pediatric population, with majority being functional and more aggressive in nature as compared to in adults. However, most of them can be approached trans-sphenoidally. The combination of surgery and radiotherapy, as well as medical therapy with bromocriptine, achieves good tumor control, despite a high rate of residual tumor and tumor recurrence.
Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, Room Number 713, VIIth Floor, New Delhi, 110029, India, sumitaiims@yahoo.com.
Sumit
S
Sinha
Avijit
A
Sarkari
A K
AK
Mahapatra
B S
BS
Sharma
D000293:Adolescent; D000367:Age Factors; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods; D010911:Pituitary Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D014786:Vision Disorders / Q000209:etiology* / Q000601:surgery