Children with Pituitary Adenomas Have Similar Outcomes as Adult Patients, Study Shows

Children with pituitary adenomas have similar responses to surgery and long-term outcomes as adult patients with the same type of tumors, new research shows.

The only exception are growth hormone (GH)-secreting tumors, which have higher recurrence rates in children than adults.

The study, “Pediatric Pituitary Adenomas: Early and Long-Term Surgical Outcome in a Series of 85 Consecutive Patients,” was published in the journal Neurosurgery.

Pituitary adenomas are benign, slow-growing tumors. While these tumors have not been associated with malignancies and have no major markers of invasiveness, they can expand into surrounding areas and invade neighboring structures and tissues.

While most pituitary tumors are non-functioning pituitary adenomas (NFPAs) that just grow in size, with no implications on hormones levels, some tumors may actively produce pituitary hormones, leading to hormone imbalance.

Pituitary adenomas are much rarer in children than in adults, and surgical outcomes in this population are poorly described. However, reports have suggested that the clinical presentation and overall outcomes are worse in pediatric patients.

Researchers at the Vita-Salute University in Italy have now reported their experience with pituitary adenomas in children.

The team reviewed responses to surgical treatment via the microsurgical transsphenoidal approach, in which the pituitary tumor is removed through the nose, and long-term outcomes of 3,040 patients with pituitary adenomas, of whom 2,917 were adults and 85 were children.

In accordance with previous reports, hormone-secreting adenomas were much more common in children (89.5%) than in adults (61%).

A total of 690 patients had ACTH-secreting adenomas causing Cushing’s disease. But surgical remission, recurrence rates, and final hormone control were all similar between adults and children. After 10 years of follow-up, the recurrence-free survival rate was 81.8% in children and 75.4% in adults.

For those with prolactin (PHL)-secreting adenomas, short- and long-term outcomes were also similar between adults and children. However, bigger tumors — macroadenomas — were more common in pediatric patients (87%) than adults (53%). Macroadenomas in children also showed increased capacity to invade surrounding tissues.

GH-secreting adenomas were also associated with similar surgical remission rates, final hormonal control, and follow-up records in adult and pediatric patients. However, more children experienced a recurrence during follow-up (40%) than adults (5.3%). The risk of recurrence was also associated with macroadenomas.

Surgical treatment of non-functioning pituitary adenomas was also found to have similar short- and long-term outcomes in both adults and children.

Researchers concluded that microsurgical transsphenoidal surgery allows “hormonal remission or complete tumor removal with preservation of pituitary function in the majority of pediatric patients, with very low morbidity and without any complications specific to this age.”

“Regular and long follow-up is important, especially in GH-secreting adenomas, as well as early diagnosis,” they added.