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- Title
Pediatric giant pituitary adenomas: are they different from adults? A clinical analysis of a series of 12 patients.
- Authors
Sinha, Sumit; Sarkari, Avijit; Mahapatra, A.; Sharma, B.
- Abstract
Objectives: To evaluate clinical presentation and microsurgical outcome of giant pituitary adenomas (GPAs) in pediatric age. Methods: All patients <18 years, who were operated on at our center for GPA (tumor >40 mm in maximum diameter) were included in study. Clinical features, hormonal profile, radiology, surgical approach, results and complications were analysed. Results: A total of 12 children with GPA were managed microsurgically. Visual deterioration (73 %) was most common presentation. Functioning adenomas were found in 83 % patients, with prolactinomas being most common. Twelve patients underwent a total of 16 microsurgical procedures, with a single surgery done in eight (75 %) patients. Out of the 12 primary surgeries, eight (67 %) were performed trans-sphenoidally. A near-total excision (>90 % tumor removal) could be achieved in six (50 %) patients. Visual improvement was observed in 44 % patients. However, there was no improvement in those where the eye was negative to perception of light prior to surgery. At the last follow-up, all the patients with functioning adenomas were in hormonal remission, and there was no residual/recurrent tumor in patients with non-functional adenomas. 25 % experienced single or multiple perioperative or postoperative complications. There was one perioperative death (8 %). Conclusions: GPAs are very rare in the pediatric population, with majority being functional and more aggressive in nature as compared to in adults. However, most of them can be approached trans-sphenoidally. The combination of surgery and radiotherapy, as well as medical therapy with bromocriptine, achieves good tumor control, despite a high rate of residual tumor and tumor recurrence.
- Subjects
PITUITARY diseases; ADENOMA; PROLACTINOMA; BROMOCRIPTINE; RADIOTHERAPY; SURGICAL complications; PATIENTS; THERAPEUTICS
- Publication
Child's Nervous System, 2014, Vol 30, Issue 8, p1405
- ISSN
0256-7040
- Publication type
Article
- DOI
10.1007/s00381-014-2421-8