Previous series of pediatric
pituitary adenomas have been small and have not been analyzed by age group. We analyzed the frequency, manifestation, course, and biology of these
tumors before, during, and after puberty in 136 children younger than 20 years old at surgery, identified by review of 2230 patients treated from 1969 to 1993.
Tumors were classified by clinical phenotype.
Adrenocorticotropic hormone-releasing
adenomas were most common before puberty, and
prolactinomas were most common during and after. The frequencies of
adrenocorticotropic hormone-releasing
adenomas,
prolactinomas, and endocrine-inactive
adenomas differed from those in adults. Growth arrest was common with all types except
growth hormone (GH)-releasing
adenomas;
menstrual irregularities were common with all but
adenomas causing
Nelson syndrome. Among girls with
prolactinomas, the preoperative duration of primary
amenorrhea was longer than that of other symptoms.
Tumor size differed by
adenoma type. Serum
hormone levels shortly after surgery correlated with the recurrence of
prolactinomas and GH-releasing
adenomas. The
prolactinoma size correlated with the maximum preoperative serum
prolactin level; boys had larger
tumors and higher preoperative and postoperative
prolactin levels. We conclude that pediatric
pituitary adenomas vary in size, age at symptom onset, and frequency before, during, and after puberty. Most
adenomas can cause
menstrual irregularities, and primary
amenorrhea should prompt investigation of the sella. Growth arrest is common with all
adenomas except GH-releasing
adenomas. Serum
prolactin and GH levels measured at 1 to 5 days after surgery indicate the risk of recurrence of
prolactinomas and GH-releasing
adenomas, respectively.