ESPE Abstracts

Background: Paediatric pituitary adenomas comprise rare but challenging pathologies in children and adolescents related to their endocrine and neurological characteristics.

Objective and Hypotheses: We aimed to describe a case report of growth hormone (GH)-secreting pituitary adenoma apoplexy.

Method: a 11-year-old girl presented with fever, sudden headache with vomiting. She abruptly developed bilateral hemianopia. On suspicion of infectious meningitis, lumbar puncture and brain MRI were performed on admission.

Results: The physical exam was normal, without neurological abnormalities except for visual disturbances. Auxological parameters were above 95^th percentile (height 2.25 SDS, weight 1.85 SDS). Biochemistry laboratory and cerebrospinal fluid analysis were normal. Brain MRI showed a 33 mm-sellar and suprasellar mass with pituitary stalk and optic chiasm dislocation and third ventricle compression; it has heterogeneous signal features and contrast enhancement, highly suggestive of hemorrhagic transformation of a pre-existing pituitary adenoma. The endocrine investigations demonstrated central hypothyroidism, hypocortisolism, GH deficiency and diabetes insipidus. The lesion was surgically removed with a transphenoidal approach. The histological examination and immunohistochemical staining were compatible with somatotroph GH-secreting adenomas diffuse necrosis and hemorrhage areas. In the postoperative period, multiple pituitary hormone replacement therapy (hydrocortisone, desmopressin, estrogen and L-thyroxine) was started with good response. GH substitution was started 7 months later.

Conclusion: Pituitary apoplexy in children and adolescents is a rare entity that requires rapid and adequate treatment to prevent a life-threatening situation. Pituitary failure may develop with the effect of adenoma itself or following surgical excision. Clinical and laboratory signals may be suggestive and MRI neuroimaging is fundamental for diagnosis.