Caroline A Steele, Ian MacFarlane, Jo Blair, Daniel J Cuthbertson, Mohammed Didi, Conor Mallucci, Mohsen Javadpour and Christina Daousi
C Steele, Diabetes & Endocrinology Clinical Research Unit, University Hospital Aintree NHS Foundation Trust, Liverpool, United Kingdom
I MacFarlane, Diabetes & Endocrinology Clinical Research Unit Liverpool,, University Hospital Aintree NHS Foundation Trust, Liverpool, United Kingdom
J Blair, Endocrinology, Alder Hey Children's NHS Trust, Liverpool, United Kingdom
D Cuthbertson, Diabetes & Endocrinology Clinical Research Unit, University Hospital Aintree NHS Foundation Trust, Liverpool, United Kingdom
M Didi, United Kingdom
C Mallucci, Neurosurgery Department, Walton Centre for Neurology and Neurosurgery, Liverpool, Liverpool, L9 7LJ, United Kingdom
M Javadpour, Neurosurgery Department, Walton Centre for Neurology and Neurosurgery, Liverpool, Liverpool, L9 7LJ, United Kingdom
C Daousi, Diabetes & Endocrinology Clinical Research Unit, University Hospital Aintree NHS Foundation Trust, Liverpool, United Kingdom
Correspondence: Caroline Steele, Email: c.steele@nhs.net
Objective: To elucidate the long-term outcomes of pituitary adenomas diagnosed in childhood and adolescence, knowledge of which remains sparse.
Design and methods: A neuroendocrine service in Liverpool, United Kingdom. Retrospective review of patients aged less than 21 years at diagnosis of pituitary adenoma during the period 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), six non-functioning adenomas (NFPA), five Cushing's disease (CD) and one acromegaly. All prolactinomas received dopamine agonists (DAs) and 3 also pituitary surgery. Ten further patients underwent surgery: all five CD, one acromegaly and four NFPA. Four received radiotherapy after surgery. Ten patients receive hormone replacement: nine hydrocortisone, five thyroxine, seven sex steroids and five growth hormone (GH); another 7 have 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/m2) since diagnosis and 16 in total are now obese (BMI >30 kg/m2). Five are treated with orlistat and one attends a weight management service. Two receive antihypertensive medications, two have type 2 diabetes and four have treated 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 have prolactinomas, all treated with DAs and three underwent surgery. Increased cardiovascular risk factors (obesity and dyslipidaemia) and infertility are important sequelae and active identification and treatment necessary.
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