ESPE Abstracts

Background: The most common conditions requiring surgery or radiation therapy of the sella and suprasellar area in childhood are craniopharygiomas and pituitary adenomas. Therapeutic procedures involving pituitary gland often lead to multiple hormonal deficiencies, and experienced multidisciplinary team following guidelines and applying systematic approach could improve outcomes.

Aim: To evaluate hormonal replacement therapy among children and adolescents with post procedural hypopituitarism.

Methods and materials: We conducted a retrospective observational study at a tertiary pediatric endocrine university center encompassing a period of 10 years (01 January 2010 to 31 December 2019). All post procedural hypopituitary patients followed for more than 1 full year were included in the study.

Results: A total of 9 patients (44% girls) with postoperative hypopituitarism consistent with the inclusion criteria were identified - 6 of them had craniopharyngiomas, 1 had meningioma, 1 - teratoma and 1 - germinoma. Mean age at diagnosis was 9.7±2.7 years (6.5 - 14). In 7 (78%) subjects total extirpation of the tumor was achieved, and in 2 subtotal excision was achieved. Only one patient was operated at our setting, 3 were operated at other centers in the country and the rest 5 patients were operated abroad. In the postoperative period, 89% of the patients developed central hypothyroidism, 89% developed diabetes insipidus, 67% had ACTH deficiency and eventually, 22% developed hypogonadotropic hypogonadism. All hormonal deficiencies were adequately replaced. Follow-up showed that all patients demonstrated growth hormone (GH) deficiency, and required treatment that started at the mean age of 12.4±2.4 years. More than half (55.5%) initiated recombinant human GH (rhGH) replacement therapy at least 2 years after tumor resection. The mean time until the start of rhGH was 3.0±2.0 years after the operation, much shorter for patient initially diagnosed by us (1.6±0.6 years) than for patients diagnosed and followed elsewhere before start of the rhGH therapy (3.8±2.2 years). No recurrence of the tumor was observed after initiation of the rhGH therapy.

Conclusion: In half of the presented patients, treatment with rhGH was delayed compared to the recommended initial timeline of 1 postoperative year. In order not to delay rhGH replacement therapy, patients with sellar and suprasellar lesions and tumors should be referred to Expert centers for rare endocrine conditions as early as possible.