Pituitary surgery found effective, safe for children with Cushing’s
Study included records of 22 children in Iran who underwent procedure
Endoscopic transsphenoidal surgery, which allows a surgeon to gain access to the brain through the nose to remove a pituitary tumor causing Cushing’s disease, was found to be safe and effective for bringing about remission in children, with few complications.
While this surgery is usually done in adults with Cushing’s disease, it’s “the recommended first-line treatment for both children and adults,” the researchers wrote.
Findings were detailed in the study, “Clinical and surgical outcomes of pediatric Cushing’s disease following endoscopic transsphenoidal surgery,” published in Child’s Nervous System.
Cushing’s disease is caused by a tumor in the pituitary gland, which is located at the base of the brain behind the bridge of the nose. A pituitary tumor can release high amounts of a hormone that signals the adrenal glands, located atop the kidneys, to produce cortisol.
While the body needs cortisol to function normally, an excess of it can result in symptoms of Cushing’s disease. In adults, common symptoms include weight gain and a buildup of fat in certain parts of the body. In children, it can also result in stunted growth.
The first-line treatment for both children and adults is usually endoscopic transsphenoidal surgery, also known as transsphenoidal adenomectomy, which allows the removal of the pituitary tumor through a hollow space that sits behind the nasal passages, with minimal damage to the surrounding tissues.
Cushing’s disease doesn’t occur often in children, and it can be difficult to diagnose. While endoscopic transsphenoidal surgery can put the disease into remission, it “presents technical challenges and requires specialized care from a highly trained pediatric neurosurgeon,” the researchers wrote.
Common symptoms included obesity, stretch marks
To better understand the outcomes of this procedure, researchers reviewed the medical records of 22 children (16 girls and six boys) who underwent surgery at a hospital in Iran.
Ages ranged from 11 to 17, and the most common first symptom was obesity or weight gain (59%), followed by menstrual changes (18.2%), and stretch marks (13.6%).
“The diagnosis is often delayed due to the reason that growth failure may be the sole symptom for an extended period of time,” the researchers wrote. However, “our series indicates that obesity and weight gain are the most common and initial symptoms of [Cushing’s disease] in pediatric patients.”
All children except one achieved remission, with blood cortisol levels dropping below 2.5 micrograms per deciliter (mcg/dL) within 48 hours after surgery or below 1.8 mcg/dL following a low-dose dexamethasone suppression test three months after surgery. One child required a second surgery because symptoms returned following remission.
During surgery, the only complication was leakage of cerebrospinal fluid (the fluid surrounding the brain and spinal cord) in three (13.6%) children.
After surgery, 11 (50%) children had hypocortisolism, or lower-than-normal cortisol levels, “an indicator of treatment success,” according to researchers. Hypothyroidism (abnormally low levels of thyroid hormones) occurred in 45.5% of the children after surgery, while hypogonadism (inability to produce sufficient amounts of sex hormones) arose in 13.6% of the children.
For children with Cushing’s disease, endoscopic transsphenoidal surgery provides “acceptable rates of remission along with minimal complications.” However, “further studies are warranted to evaluate long-term outcomes and optimize treatment protocols,” the researchers wrote.
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