ESPE Abstracts

Background: Hypopituitarism is a rare condition characterized by the insufficiency of 2 and more hormones produced by anterior pituitary gland. The major causes of hypopituitarism are brain tumors located near or in the pituitary gland and/or hypothalamus, cranial radiation, chemo- or surgical therapy, cranial traumas, neuroinfections, autoimmune hypophysitis (immune-mediated inflammation of pituitary gland) etc. Brain tumors are the second most frequent type of all pediatric malignancies. Depending on their localization patients with brain tumors may present neurological and/or ophthalmological symptoms, as well as weight anomalies and endocrine disorders ranging from growth hormone deficiency (GHD), hypogonadism (delayed puberty) to panhypopituitarism and diabetes insipidus (DI), alternately called arginine vasopressin deficiency (AVP-D). Antidiuretic hormone is not synthesized in the anterior pituitary but is stored and released into the blood from the posterior pituitary, and thus not every hypopituitarism is associated with DI/AVP-D.

Objectives: The aim of the current work is to evaluate and describe the some characteristics of patients <18 years of age with hypopituitarism in Armenia.

Methods and Results: 16 patients with hypopituitarism were enrolled in this study, from which 9 boys and 7 girls. The average age of patients at diagnosis was 8.6 years (4-15), in 56% of patients hypopituitarism occurred in prepuberty - before the age of 8y. Out of 16 patients 5 had meduloblastoma, 1 - craniopharyngioma, 1 – Hodgkin’s’ lymphoma, 1 – pituitary macroadenoma, and 8 – other cause of hypopituitarism, including septo-optic dysplasia. Hypopituitarism was associated with DI/AVP-D in 8 patients (50%), from which only 3 was post-surgical. Almost all cases (94%) of hypopituitarism were accompanied by secondary hypothyroidism, and 88% - by GHD, and only 75% - by secondary hypocorticism. Interestingly, 7 out of 8 (87.5%) tumor cases are treated with GH after surgical and/or chemotherapy without tumor re-occurrence.

Conclusion: DI/AVP-D is not a common disorder in post-operative hypopituitarism, but the most common is hypothyroidism, then GHD and then hypocorticism. All the children with cranial tumors, regardless the type of it, should be followed by the pediatric endocrinologist before and after the tumor treatment.