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

Abstract

Objectives: To evaluate clinical presentations, diagnosis and management of paediatric patients presenting with pituitary apoplexy.

Methods: A 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.

Results: Pituitary 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.

Conclusions: With only a limited number of published case reports surrounding this topic our case series contributes to help further understand and manage this condition.

Keywords: Adenoma; Apoplexy; Children; Endoscopic; Haemorrhage; Pituitary; Prolactinoma; Surgery; Trans-sphenoidal.

Fig. 1

Pre-operative T1 weighted MR image of Child 1 showing a pituitary macroadenoma causing chiasmal compression with extensive high T1 signal within the lesion in keeping with tumour haemorrhage

Fig. 2

Child 4—Coronal unenhanced T1 MRI showing a tumour splaying the optic chiasm

Fig. 3

Child 4—Sagittal T2 weighted imaging shows a fluid/blood level in keeping with haemorrhage

Fig. 4

Child 5’s T2 weighted MRI showing a large suprasellar mass with right parasellar extension, displacing the right internal carotid artery. There is evidence of central necrotic change and blood-fluid levels

Fig. 5

Child 1’s post-operative image showing complete tumour clearance