Thursday, August 5, 2010

Pituitary Adenomas In Childhood, Adolescence and Young Adulthood: Presentation, Management, Endocrine and Metabolic Outcomes.

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.

 

From http://www.eje.org/cgi/content/abstract/EJE-10-0519v1