Transsphenoidal Surgery for Pituitary Adenomas in Children

Abstract

The authors have reviewed the results of transsphenoidal surgery for pituitary adenomas done on 66 children (younger than 16 yr of age) between 1966 and 1992. Ninety-four percent (62 of 66) showed clinical evidence of pituitary hormonal hypersecretion. The most common type was the adrenocorticotropic hormone-secreting adenoma (n = 36), followed by the prolactinoma (n = 18) and the growth hormone-secreting types (n = 8). There were four cases of nonfunctioning adenomas. Adrenocorticotropic hormone-secreting tumors in children had presentations and surgical results similar to those seen in adults. Twenty-three of 33 patients with Cushing's disease had simple adenomectomy or subtotal hypophysectomy without symptomatic recurrence. Four of 10 initial treatment failures had subsequent successful surgical intervention, resulting in an overall cure rate of 78%. Postoperative hypocortisolism was suggestive of surgical success but was not absolute. Of three patients with Nelson syndrome, none were successfully treated with surgery alone and two developed invasive disease. Prolactin-secreting and growth hormone-secreting tumors in children occurred more commonly with suprasellar expansion than did their adult counterparts. Transsphenoidal surgery was capable of controlling disease in only 12% (1 of 8) of growth hormone-secreting tumors, and 67% (12 of 18) of prolactin-secreting tumors required postoperative medical therapy or radiotherapy for persistently elevated prolactin levels. Special difficulty was noted in boys with prolactinomas and in girls with primary amenorrhea. As in adults, preoperative prolactin levels correlated with ultimate surgical success rates.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical management of pediatric Cushing's disease: an analysis of 15 consecutive cases at a specialized neurosurgical center

“…However, there was a remarkable improvement of surgical cure (85.7%) in the latter ten years. In the literature, surgical cure rates range from 40% to 100% (mean: 70.5%), according to table 2 (4)(5)(6)12,13,(20)(21)(22)(23)(24)(25)(26)(27)(28). In the present study, plasma cortisol levels considered were < 1.8 μg/dL during the first days after surgery for cure definition -this is a very strict criterion.…”

Factors influencing cure by transsphenoidal selective adenomectomy in paediatric Cushing’s disease

“…In our centre, TSS had a current cure rate of 59% in paediatric CD, where cure was strictly defined as being reflected by a post-operative serum cortisol of less than 50 nM. Other paediatric series report cure rates ranging from 45% to 78% (12,25,27,30,31,32), but few report rates of . 90% (5,33).…”

Pituitary adenomas in childhood, adolescence and young adulthood: presentation, management, endocrine and metabolic outcomes

“…TSS for removal of ACTH-secreting adenomas can be technically challenging in children and the failure rate even in the most experienced hands can be significant. Cure rates reported from paediatric studies vary between 45 and 97% (14,(23)(24)(25)(26)(27)(28). Lifelong follow-up is mandatory, due to the possibility of recurrence after initial cure.…”

“…Previous studies have tended to report either the clinical features at presentation (2,8,11) or the results of surgery (3,10,14) with outcomes described in terms of visual field deficits, normalisation of hormones (in secreting tumours), loss of pituitary hormone function, remission/cure or the need for further treatment (radiotherapy or repeat surgery) for residual tumour (6,7). In addition to these factors, we were also interested in investigating long-term sequelae, such as impaired fertility, which has been described in both adult patients with pituitary adenomas (15) and in those with hypopituitarism from various causes (e.g.…”