Clinical presentation and outcome of pituitary adenomas in teenagers

• Published in: Clinical endocrinology (Oxford) Vol. 58; no. 4; pp. 519 - 527
• Main Authors: Cannavò, S., Venturino, M., Curtò, L., De Menis, E., D'Arrigo, C., Tita, P., Billeci, D., Trimarchi, F.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01-04-2003; Blackwell; Wiley Subscription Services, Inc
• Subjects: Adenoma - complications; Adenoma - diagnosis; Adenoma - physiopathology; Adolescent; Adrenocorticotropic Hormone - metabolism; Adult; Biological and medical sciences; Child; Endocrinopathies; Female; Growth Hormone - metabolism; Headache - etiology; Humans; Hypothalamus. Hypophysis. Epiphysis (diseases); Magnetic Resonance Imaging; Male; Medical sciences; Menstruation Disturbances - etiology; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Pituitary Function Tests; Pituitary Neoplasms - complications; Pituitary Neoplasms - diagnosis; Pituitary Neoplasms - physiopathology; Prolactinoma - complications; Prolactinoma - diagnosis; Prolactinoma - physiopathology; Puberty, Delayed - etiology; Retrospective Studies; Tomography, X-Ray Computed; Endocrinopathy; Human; Prognosis; Clinical form; Adenoma; Secretory tumor; Symptomatology; Treatment; Age of onset; Pituitary diseases; Adolescent; Complication; Pituitary gland; Benign neoplasm; Child
• ISSN: 0300-0664; 1365-2265
• DOI: 10.1046/j.1365-2265.2003.01748.x

Summary
objective Pituitary adenomas rarely occur in childhood and adolescence, but their mass effect and endocrine abnormalities can compromise both quality and length of life. In this study we evaluated the symptoms at onset and the long‐term consequences induced in teenagers by functioning or nonfunctioning pituitary adenomas.
design and patients Clinical, biochemical and neuroradiological data of 44 young patients (12 males and 32 females, aged 16·3 ± 1·9 years at diagnosis) with pituitary adenomas were evaluated retrospectively at baseline and after therapy. Patients underwent surgery, radiotherapy and/or medical treatment depending on clinical history and endocrine secretion of the tumour. Follow‐up ranged from 8 to 252 months (median 55 months).
measurements Baseline and dynamic pituitary function were evaluated in all cases at diagnosis and after treatments. Magnetic resonance imaging (MRI) or computed tomography (CT) scan were performed before therapy and during follow‐up. Hormone levels were measured using commercial radioimmunologic or immunoradiometric methods.
results Pituitary macroadenomas (group 1) or microadenomas (group 2) were found in 61% and 39% of cases, respectively. Overall, 68% were PRL‐secreting, 7% GH‐secreting, 5% ACTH‐secreting and 20% nonfunctioning. The most frequent symptoms at onset were oligoamenorrhoea (62%) and galactorrhoea (59%) in the girls, and headache (58%) in the boys. Pubertal development was delayed in 12/27 (44%) cases with macroadenoma. Growth failure was observed in 4/44 (9%) patients (3 in group 1 and 1 in group 2). At diagnosis, hypopituitarism was detected in 10/27 (37%) patients with macroadenoma. Surgery alone cured 4/18 (22%) and 4/9 (44%) patients in group 1 and group 2, respectively. Adjuvant therapies (second surgery and/or radiotherapy and/or medical treatment) cured the disease in 2/13 (15%) patients with macroadenoma and allowed a persistent normalization in other 4/13 (31%) and 2/4 (50%) cases in group 1 and group 2, respectively. Medical treatment alone cured 2/9 (22%) patients with PRL‐secreting macroadenoma and normalized PRL levels in another six (66%) with macroprolactinoma and in 2/7 (28%) patients with microprolactinoma.
conclusion Delay of growth was rarely observed in teenagers with pituitary adenomas. At the onset of the disease, many girls complained of oligoamenorrhoea and galactorrhoea, while headache and delay of pubertal development were the symptoms more frequently referred by boys. Surgery alone was effective in a minority of patients and adjuvant therapies were helpful to obtain the remission of the disease in many cases. In patients with PRL‐secreting pituitary adenoma, medical treatment, both as first choice or as adjuvant therapy, normalizes serum PRL levels in 14/27 (52%) cases.