Magnetic resonance imaging has dramatically improved the diagnostic accuracy in the evaluation of the hypothalamo-pituitary region and investigation of morphological and structural pituitary abnormalities.
Aim: To estimate pituitary dysfunction types and clinical presentation of pituitary lesions on MRI investigation, assigned as hypointense intrasellar mass (microadenoma-MA).
Patients and methods: We examined 19 children and adolescents aged from 5 to 17.5 years (mean 12.24) with microadenomas. Assessment of growth, pubertal staging and complete evaluation of basal pituitary function were carried out in all patients. Dynamic tests of somatotropic, corticotropic and gonadotropic functions were done where appropriate.
Results: At admission 4 patients with microprolactinomas presented short stature, obesity gynecomastia and puberty disorders and additional 6 with non functioning microadenomas (NFMAs) presented short stature and delayed puberty. Four patient had precocious puberty, one male with beta subunit secreting microadenoma, and 3 females with non functioning pituitary micro adenomas. Among two adolescents with tall stature and NFMA one have delayed puberty. Adolescent with prolonged gynecomastia was diagnosed, due to dynamic tests, as primary hypothyroid and with hyperprolactinaemia. Also intetisting results were found in 4 obese adolescent girls with secondary amenorrhea. Although with normal basal hormonal status, they underwent meticulous dynamic investigation, because of presence of pituitary lesions, and we discovered primary hypothyroidism and hyperprolactinaemia in all of them. Appropriate treatment led to shrinkage or complete radiological resolution of MAs.
Conclusion: Children and adolescents with pituitary MRI lesions, assigned as MA presented a wide variety of clinical characteristics. MRI finding of MA obligated us to perform a careful dynamic examination in patients with normal basal hormonal status and allowed accurate diagnosis and treatment. Clinical presentation even in NFMA is evidence of hypothalamic dysfunction, not always detectable even in dynamic tests.
30 Apr - 04 May 2011
European Society of Endocrinology