Pituitary tumour apoplexy within prolactinomas in children: a more aggressive condition?

Elizabeth Culpin,Mark Igra,Showkat Mirza,Daniel J A Connolly,Matthew Crank,Paul Dimitri,Saurabh Sinha

doi:10.1007/s11102-018-0900-8

Abstract

ObjectivesTo evaluate clinical presentations, diagnosis and management of paediatric patients presenting with pituitary apoplexy.MethodsA retrospective case series describing a cohort of paediatric patients presenting with this condition from 2010–2016 to a tertiary referral children’s hospital in the United Kingdom.ResultsPituitary apoplexy is a rare condition that seems to have a higher relative incidence in children than adults. Our series suggests that pituitary apoplexy in paediatric patients with adenomas appears more common than previously described. All our patients required surgery, either as an acute or delayed procedure, for visual compromise. Two patients had commenced growth hormone (GH) for GH deficiency two weeks prior to the onset of pituitary apoplexy.ConclusionsWith only a limited number of published case reports surrounding this topic our case series contributes to help further understand and manage this condition.

Highlights

Pituitary adenomas in children are rare with a prevalence of one per million and almost never malignant [1]
We present a series of paediatric patients presenting with pituitary tumour apoplexy to help better understand this rare condition
We present a case series of five paediatric patients

Summary

Background

Pituitary adenomas in children are rare with a prevalence of one per million and almost never malignant [1]. They account for < 6% of all adolescent intracranial tumours and < 3% of childhood supra-tentorial tumours [2]. We present a series of paediatric patients presenting with pituitary tumour apoplexy to help better understand this rare condition. We present a case series of five paediatric patients, Age range 13–16 year) all of whom presented as an emergency to a tertiary referral children’s hospital since 2010, with pituitary tumour apoplexy. All the patients were noted to have prolactinomas. An MRI [Fig. 1] identified an apoplectic suprasellar tumour with a prolactin of

15 M Headaches visual loss cavernous sinus syndrome

Discussion

Conclusion

Findings

Compliance with ethical standards