Pituitary incidentalomas in paediatric age are different from those described in adulthood

Souteiro, Pedro; Maia, Rúben; Silva, Rita Santos; Figueiredo, Rita; Costa, Carla; Belo, Sandra; Castro-Correia, Cíntia; Carvalho, Davide; Fontoura, Manuel

doi:10.1007/s11102-019-00940-4

Cited by 22 publications

(28 citation statements)

References 26 publications

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“…In our study, we reported the incidence of PI over a 9‐year period among patients less than 18 years old, and it appeared to be 22 per 1000 patients. Similar to our results, Souteiro et al 2 reported an incidence of PI in children of 257 per 100 000 patients‐year (or 26 per 1000 patients), a result slightly higher than what we obtained. However, we have only utilized contrast enhanced MRIs in our study and not CT, whereas both modalities were looked at in Souteiro et al Furthermore, it is worth noting that the most common PI encountered in the latter study was pituitary hypertrophy, which is likely of no clinical sequelae and as further detailed in the paragraph labelled ‘Pituitary hyperplasia and pituitary hypertrophy’.…”

Section: Discussionsupporting

confidence: 89%

“…The prevalence of pituitary microadenoma was 5 per 1000 and that of incidental microadenoma is 2 per 1000. Pituitary microadenoma in our study represented 12.9% of incidental lesions, similar to Souteiro et al (14.6%) 2 . This is in contrast to the adult age group where the prevalence of incidental adenomas reaches 16.7% 3 and adenomas represent the majority of PIs, reaching up to 90% 22 .…”

Section: Discussionsupporting

confidence: 88%

“…The incidentalomas’ prevalence in the sellar and parasellar regions has increased with technological advances. Yet, the vast majority of the existing literature on the prevalence and incidence of PI deals with the adult population 2 . In the largest meta‐analysis of autopsy studies, Molitch et al 3 reported an average mean prevalence of 10.7% PI (1.5%‐27%).…”

Section: Introductionmentioning

confidence: 99%

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Pituitary incidentalomas in paediatric population: Incidence and characteristics

Shareef

Nasrallah

AlArab

et al. 2020

Clinical Endocrinology

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ObjectiveTo determine the incidence of pituitary incidentalomas in the paediatric population and among its different age subgroups as well as to identify the characteristics of these lesions. Additionally, we aim to give a perspective on the management and follow‐up of these patients.Design and PatientsWe retrospectively studied MRI of children aged 18 years or below who underwent MRI with sellar region within their field of view between January 2010 and December 2018.MeasurementsPituitary lesions were considered incidental according to the definition by the Endocrine Society. We reported the size, location and signal characteristics of each lesion. Medical charts of the subjects were reviewed for age, sex, the MRI indication and the hormonal assays levels.ResultsWe identified 40 pituitary lesions of which 31 were incidental lesions. The incidence of pituitary incidentaloma in our cohort was 22 per 1000 patients with female predisposition ( 64.5%) and a mean age of 11 ± 6 years. Rathke's cleft cyst was the most prevalent lesion, accounting for 67.7% followed by cystic pituitary lesions and microadenomas. The most common indications for imaging were growth disturbance (12.9%) followed by headache (9.7%). Abnormal laboratory workup was present in 13% of the subjects. Incidental lesions were more common in the older age groups compared to young children.ConclusionIncidental pituitary lesions in the paediatric population are relatively infrequent and increases with age. Rathke's cleft cyst is the most common incidentally encountered pituitary lesion followed by cystic pituitary lesions and microadenomas.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

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Pituitary incidentalomas in paediatric population: Incidence and characteristics

Shareef

Nasrallah

AlArab

et al. 2020

Clinical Endocrinology

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“…Another study on children aged 2-16 years noted "certain" and "possible" microadenomas in 28.6 and 21.4%, respectively, of the children without hormonal abnormalities (n = 528) (23). In another study, 41 children aged below 18 years were identified with pituitary "incidentalomas" during evaluation of CNS symptoms and signs such as headache, of which 6 (14.6%) were microadenomas (24). Recently, a study reported that asymptomatic non-functional pituitary lesions, including cysts, microadenomas, or possible microadenomas follow a benign clinical course in children.…”

Section: Discussionmentioning

confidence: 97%

Pathological and Incidental Findings in 403 Taiwanese Girls With Central Precocious Puberty at Initial Diagnosis

Chiu

Chen

2020

Front. Endocrinol.

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Background: Whether girls with central precocious puberty (CPP) should undergo routine brain magnetic resonance imaging (MRI) to identify potential intracranial pathologies is controversial. Aims: To evaluate the brain MRI results of girls with CPP and identify the clinical and endocrine predictors of brain abnormalities. Methods: This retrospective study obtained data from pediatric endocrine clinics at Chang Gung Children's Hospital. From 1997 and 2017, 403 girls were consecutively diagnosed with CPP. After the exclusion of patients with a history of central nervous system (CNS) insults or associated neuropsychiatric symptom or signs, we studied the prevalence of brain abnormalities in 251 girls with CPP who received detailed MRI examinations of the hypothalamus and pituitary area. We also recorded the demographic data of the participants, including the onset of puberty; initial pubertal status; height; weight; uterus and ovary sizes; and basal luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol levels, and the response to GnRH stimulation test. Results: Among the 251 girls with CPP, we observed no brain alterations in 190 (75.70%), abnormalities in the hypothalamic-pituitary (H-P) area in 54 (21.51%), and abnormalities in the non-H-P area in 7 (2.79%). Among the 54 patients that had H-P lesions, we noted pathological findings related to CPP (hypothalamic hamartoma) in only one (0.4%) girl aged below 6 years old. We also identified incidental findings in the other girls with H-P lesions, including non-functioning pituitary microadenomas (12.35%), pituitary pars intermedia cysts (4.38%), Rathke's pouch cysts (1.99%), pituitary hypoplasia (1.59%), and pineal gland cysts (0.8%). The patients that had non-H-P lesions were found to have arachnoid cysts (1.59%), Chiari I malformation (0.4%), prepontine nodule (0.4%), and choroidal fissure cyst (0.4%). Of all the patients with brain lesions, 45 (73.77%) underwent regular MRI follow-up. While none of the H-P and non-H-P lesions showed progression, 19.67% of these regressed during the follow-up. None of the participants exhibited other hormonal abnormalities or underwent surgery. Conclusion: The prevalence of true pathological brain lesions related to CPP in girls without prior symptoms or signs of CNS lesions was low (0.4%). None of the girls with intracranial lesions required further intervention besides the GnRH agonist treatment. These data question the routine use of brain MRI in all girls with CPP, especially in those who are healthy without neurologic symptoms.

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“…Pituitary adenomas (PAs) are common lesions in the adult population presenting in 15-20% of cadavers or radiologic findings and constitute approximately 10% of all intracranial tumors [1,2]. PAs are rarer in the pediatric population identified in 0.2% of children undergoing brain imaging [3]. Although most of the identified PAs are incidental findings without the need for intervention, some may present as clinically significant because they secrete hormones or cause symptoms from compression or invasion of surrounding tissues [4].…”

Section: Introductionmentioning

confidence: 99%

The Genetics of Pituitary Adenomas

Tatsi

Stratakis

2019

JCM

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The genetic landscape of pituitary adenomas (PAs) is diverse and many of the identified cases remain of unclear pathogenetic mechanism. Germline genetic defects account for a small percentage of all patients and may present in the context of relevant family history. Defects in AIP (mutated in Familial Isolated Pituitary Adenoma syndrome or FIPA), MEN1 (coding for menin, mutated in Multiple Endocrine Neoplasia type 1 or MEN 1), PRKAR1A (mutated in Carney complex), GPR101 (involved in X-Linked Acrogigantism or X-LAG), and SDHx (mutated in the so called "3 P association" of PAs with pheochromocytomas and paragangliomas or 3PAs) account for the most common familial syndromes associated with PAs. Tumor genetic defects in USP8, GNAS, USP48 and BRAF are some of the commonly encountered tissue-specific changes and may explain a larger percentage of the developed tumors. Somatic (at the tumor level) genomic changes, copy number variations (CNVs), epigenetic modifications, and differential expression of miRNAs, add to the variable genetic background of PAs.

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Pituitary incidentalomas in paediatric age are different from those described in adulthood

Cited by 22 publications

References 26 publications

Pituitary incidentalomas in paediatric population: Incidence and characteristics

Pituitary incidentalomas in paediatric population: Incidence and characteristics

Pathological and Incidental Findings in 403 Taiwanese Girls With Central Precocious Puberty at Initial Diagnosis

The Genetics of Pituitary Adenomas

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