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Journal of Korean Neurosurgical Society 1995;24(8): 864-875.
Pituitary Adenomas in Childhood and Adolescence.
Eun Young Kim, Joong Uhn Choi, Sang Sup Chung, Kyu Chang Lee, Duk Hi Kim
1Department of Neurosurgery, Yonsei University, College of Medicine, Seoul, Korea.
2Department of Pediatrics, Yonsei University, College of Medicine, Seoul, Korea.
ABSTRACT
Between 1989 and 1993, 13 patients with pituitary adenoma underwent operation/radiosurgery at Yonsei University Hospital before their 18th birthday. This comprises an incidence of 5.3%(13/247) of all pituitary adenoma patients who were treated at our institution during the study period. There were 7 boys and 6 girls ranging in age from 10.6 to 17.9 years(average, 14.9 years). The mean follow-up period was 22.4 months(7-55 months). Immunohistochemical study revealed 4 prolactin(PRL)-secreting, 3 growth hormone(GH)-secreting(PRL was also positive in one), 1 adrenocortical hormone(ACTH)-secreting, 1 thyroid stimulating hormone(TSH)-secreting, and 4 non-functioning adenomas. Nine of 13 patients(77%) presented with symptomatic endocrinopathy due to hormonal hypersecretion and/or delay in linear growth or onset of puberty. Microadenomas comprised one of nine functionng adenomas, and one of 4 nonfunctioning adenomas, or 15% overall. In 10 patients(77%), at least one pituitary hormonal axis was abnormal. Transsphenoidal and transcranial resections were employed in 8 and 4 patients, respectively. One patient with nonfunctioning microadenoma underwent gamma knife radiosurgery. Endoclinologically successful treatment was possible in 4 of 9 functioning adenomas(44%). Gross total resections confirmed by follow-up study were achieved in 2 of 3 nonfunctioning adenomas. One nonfunctioning microadenoma treated by radiosurgery showed no progression on follow-up study 20 months after radiosurgery. Seven patients(54%) were treated successfully with either operation or radiosurgery. Adjuvant therapy was applied to 5 patients. Overall tumor control was achieved in 91%. Long-term partial or full hormone replacement was necessary in 69%. It is concluded that early diagnosis, vigorous approach to complete cure, and more strict endocrinological management for sexual maturation and growth are mandatory in management of pediatric pituitary adenomas.
Key Words: Pituitary adenoma; Adolescence; Transsphenoidal approach; Radiosurgery
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