“When these tumors occur in children, the manifestations are often different than in adults.“
Post by
Andrew Norris, MD PhD
Director, Pediatric Endocrinology & Diabetes
University of Iowa Stead Family Children’s Hospital
A concise review of hormone-secreting pituitary tumors and their clinical syndromes appears in today’s New England Journal of Medicine. The article starts by noting that hormone secreting pituitary adenomas account for ~15% of all intercranial tumors. Although the article is informative and well written, it largely omits the characteristics of these disorders in childhood. When these tumors occur in children, the manifestations are often different than in adults. Below I have tabulated the anterior pituitary hormones that can be oversecreted by pituitary adenomas, and their common related childhood syndromes / symptoms. The table is listed in order of prevalence, from occasional to exceedingly rare (just a few case reports ever). Some of the symptoms of these conditions are common and non-specific (e.g. headache) and usually do not indicate a pituitary adenoma. Other symptoms almost always warrant an endocrine workup, especially growth failure, galactorrhea, precocious puberty, pubertal failure, gigantism, and acromegaly. On the flip side of hormone-secreting adenomas are pituitary adenomas that do not secrete hormones. Even though such adenomas do not secrete hormones, they eventually can lead to symptoms once their size impinges on local function. These manifestations can include visual field defects, headache, deficiency of pituitary hormones though prolactin can be modestly elevated due to pituitary stalk compression. Importantly, hormone secreting adenomas can also lead to these size-related effects as well.
| Hormone oversecreted | Childhood manifestations |
| Prolactin (prevalence ~1/10,000) | Menstrual disturbance (girls) Galactorrhea (girls) Gynecomastia (boys) Pubertal delay/failure (boys) |
| ACTH (incidence <1/million/yr) | Weight gain Growth failure Striae Hypertension Amenorrhea (girls) Hirsutism (girls) |
| Growth hormone (rare) | Gigantism Acromegaly |
| TSH (exceedingly rare) | Hyperthyroidism Headache |
| LH, FSH (exceedingly rare) | Precocious puberty |
- Pediatric Relevant References:
- prolactin: one two three
- ACTH: one two
- growth hormone
- TSH
- FSH/LH,
- hormone-silent adenomas.