Pediatric and adolescent somatotrop adenomas
F. Chentli1, S. Azzoug1, F. Belhimer1, M. Amani2 & D. Meskine3
Introduction: Pituitary somatotrop adenomas are very rare in children and adolescents. They are supposed to be more invasive (invasion of cavernous sinuses or meninges±compression of adjacent neural structures) than adultsones. We aimed to analyze their characteristics, and their complications.
Patients and subjects: are studied subjects whose clinical symptoms began before 20 years old. They all had biological, hormonal, ophthalmological, radiological explorations (TDM and or cerebral MRI) and histological study.
Results: From this retrospective study, we have collected 27 cases: 21 pures GHomas and 6 mixed adenomas (PRL/ GH). 20 were males and seven females. Mean age at diagnosis was 24.5±8.5 years (1255). Clinical symptoms were: 16 gigantisms±acromegaly, and 11 acromegalies without gigantism. 18 tumors invaded the cavernous sinuses and/or the meninges (66.6%), and 11 were giants (height ≥4 cm) or huge (≥6 cm)=40.7%. Mean plasma GH=125.7±200 ng/ml (7840). Complications were: pituitary insufficiency (≥1 deficit: 24=88.8%, ≥2 deficits:13=48%), hydrocephaly=7=25.9%, psychiatric troubles=4=14.8%, epilepsy=3 (11%), blindness of one or both eyes: 5=18.5%, glucose disorders=12=44.4%, dyslipidemia=13=48%, systemic hypertension=1, dilated or hypertrophic cardiomyopathy=6=22.2%, arterioneuropathy=1, bone problems=5. Association with a benign tumor was observed in 3 cases=11%.
Conclusion: Children and adolescents somatotrop adenomas are diagnosed late. They prevail in males. They are often invasive, and giant or even huge which explains their numerous and severe cerebral complications. The resulting severe hypersomatotropism is responsible of metabolic, bone, and heart complications. On another side, a possible vicious circle between large tumors and severe hypersomatotropism is not excluded.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.