Endocrine Abstracts

There as increasing recognition of pituitary adenomas, mostly due to increased imaging, a trend seen both in adults and children. Recently, the first guideline has been published on paediatric pituitary adenoma s outlining diagnostic pathways an management. Key messages include emphasis is on early diagnosis, care in centres of excellence in pituitary adenomas, the importance of discussion with ‘adult’ endocrinologist colleagues, genetic testing, novel imaging modalities, novel radiotherapy options, indications and issues with access to medications. For paediatric prolactinomas, the most common tumour type, the key discussion points are the importance of medical treatment, considering long-term side effects, genetics and ruling out alternative causes of hyperprolactinaemia (drug, dopamine pathway abnormality). For GH excess, early diagnosis can be hindered by differentiation from constitutional tall stature and other pathological causes of tall stature. Access to medication (GH receptor antagonist, 2^nd generation somatostatin analogue) and prevention of long-term debilitation consequences are key. Genetics plays the largest role in this type of paediatric pituitary adenoma and family history as well as associated other manifestations are key for the correct diagnosis. Follow up of gene carrier children with a disease associated with low penetrance has the advantage of picking up disease early; however, it has its own challenges generating anxiety and screening fatigue. In paediatric Cushing’s disease, high quality imaging (dynamic, volumetric), potentially including novel methods, access to experienced pituitary surgeon and rarely genetic aspects (germline MEN1, somatic USP8) are current hot topics. Small non-functioning lesions are often stable, but we suggest following them and handover to adult services for potential discharge later. Non-functioning macroadenomas in children usually need to be operated eventually if show growth or hormonal/visual complications. TSHomas are rare, can occur both in micro and macroadenomas, and thyroid hormone resistance represents the main differential diagnostic problem. The nationwide/international monthly case presentation meeting Hypothalamic Pituitary Axis Tumours (HPAT) meetings is extremely successful providing expert opinion and management support for these often rare and complex conditions and we strongly encourage all colleagues to present paediatric pituitary adenoma cases here.