ESPE Abstracts

Introduction: The clinical spectrum of nonfunctioning pituitary adenomas (NFPA), which are rare in childhood, varies from asymptomatic to hypopituitarism and/or severe compression-associated symptoms. We present the diagnosis, follow-up, and treatment of pediatric NFPA cases evaluated in a pituitary referral center.

Methods: Data of patients aged <18 years and diagnosed with NFPA between 2002 and 2024 were reviewed retrospectively. Demographic data, clinical findings, and tumor characteristics were evaluated.

Results: NFPA (n = 49) constituted 44.5% of all pediatric pituitary adenomas (n = 110). The median age was 12.7(6.4-18), weight SDS was +2.04 (-3.84/+5.09), height SDS was 1.98 (-3.51/+3.68), BMI SDS was 1.54 (-2.76/+4.04). Median (range) size was 6.5 (2.3-30) mm, and follow-up time was 6.5 (3-147) months; female gender predominated (69.4%). Presenting symptoms are summarized in Table 1. All nine cases with macroadenoma had cavernous sinus invasion and/or optic chiasm compression and underwent surgery. 8/9 had at least one pre-surgical pituitary hormone deficiency [central adrenal insufficiency (n = 5) hypogonadotropic hypogonadism (n = 3), growth hormone deficiency (GHD; n = 2), central hypothyroidism (CH; n = 2)]. The most common hormonal deficiencies associated with microadenoma were GHD (21.8%) and CH (9.3%). MRI indications in cases with microadenoma were; short stature (n = 8), hyperprolactinemia (n = 8), headache (n = 6), galactorrhea (n = 4), precocious puberty (n = 3), menstrual irregularity (n = 2), tall stature (n = 2), polydipsia (n = 1), visual impairment (n = 1), epilepsy (n = 1), hypercortisolemia (n = 1), obesity (n = 1), atypical diabetes (n = 1) and trauma (n = 1). Total spontaneous regression (TSR) occurred in nine (22.5%) of the microadenomas at a median of 20 (6-42) months, adenoma shrinkage was observed in four (10%) at a median of 48 (7-81) months, growth in two (5%), and no change in nine (22.5%). TSR was observed in 2/7 (28.5%) cases receiving growth hormone replacement therapy (GHRT), while the adenoma size of one (14.2%) was unchanged, one (14.2%) shrank and one (14.2%) enlarged.

Discussion & Conclusion: When evaluating pediatric patients with endocrinological complaints such as short stature, precocious puberty, obesity, and menstrual irregularity, as in our study, patients with NFPA may be diagnosed early. GHRT appeared to be safe.