between 1989 and 1993. 13 patients with pituitary adenoma underwent operation/radiosurgery at Yonsei University Hospital before their 18th birthday. This comprises an incidence of 5.3% (13/247) of all pituitary adenoma patients who were treated
at
our
institution during the study period. There were 7 boys and 6 girls ranging in age from 10.6 to 17.9 years (average. 14.9 years). The mean follow-up period was 22.4 months (7-55 months).
Immunohistochemical study revealed 4 prolactin (PRL-secreting, 3 growth hormone (GH)-secreting (PRL was also positive in one), 1 adrenocortical hormon (ACTH)-secreting, 1 thyroid stimulating hormone (TSH)-secreting, and 4 non-functioning
adenomas.
Nine
of 13 patients (77%) presented with symptomatic endocrinopathy due to hormonal hypersecretion and/or delay in linear growth or onset of puberty. Microadenomas comprised one of nine functioning adenomas, and one of 4 nonfunctioning adenomas, or
15%
overall. In 10 patients (77%), at least one pituitary hormonal axis was abnormal.
Transsphenoidal and transcranial resections were employed in 8 and 4 patients, respectively. One patient with nonfunctioning microadenoma underwent gamma knife radiosurgery. Endoclinologically successful treatment was possible in 4 of 9
functioning
adenomas (44%). Gross total resections confirmed by follow-up study were achieved in 2 of 3 nonfunctining adenomas. One nonfunctioning microadenoma treated by radiosurgery showed no progression on follow-up study 20 months after radiosurgery.
Seven
patients (54%) were treated successfully with either operation or radiosurgery. Adjuvant therapy was applied to 5 patients. Overall tumor control was achieved in 91%. Long-term partial or full hormone replacement was necessary in 69%.
It is concluded that early diagnosis, vigorous approach to complete cure, and more strict endocrinological management for sexual maturation and growth are mandatory in the management of pediatric pituitary adenomas.
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