Introduction: To evaluate clinical presentation and microsurgical outcome of giant pituitary adenomas (GPA) in pediatric age.
Methods: All patients <18 years, operated at our center for GPA (tumor >40 mm in maximum diameter) were included in study. Clinical features, hormonal profile, radiology, surgical approach, results and complications were analysed.
Results: A total of twelve children with GPA were managed microsurgically. Visual deterioration (73%) was most common presentation. Functioning adenomas were found in 83% patients, with prolactinomas being most common. Twelve patients underwent a total of 16 microsurgical procedures, with a single surgery done in 8 (75%) patients. Out of the 12 primary surgeries, 8 (67%) were performed trans-sphenoidally. A near-total excision (>90% tumor removal) could be achieved in 6 (50%) patients. Visual improvement was observed in 44% patients. However, there was no improvement in those where the eye was negative to perception of light prior to surgery. At the last follow up, all the patients with functioning adenomas were in hormonal remission, and there was no residual/ recurrent tumor in patients with non-functional adenomas. 25% experienced single or multiple perioperative or postoperative complications. There was one perioperative death (8%).
Conclusions: GPA are very rare in pediatric population, with majority being functional and more aggressive in nature as compared to in adults. However, most of them can be approached transsphenoidally. The combination of surgery and radiotherapy, as well as medical therapy with bromocriptine, achieves good tumor control, despite a high rate of residual tumor and tumor recurrence.
Patient Care: Giant pituitary adenomas are very rare in paediatric age. the study describes the behaviour, clinical presentation and surgical results of these tumours in paediatric age group. and this is the single largest series of such tumours in this age.
Learning Objectives: by the conclusion of this session, participant should be able to understand that 1) clinical presentation of giant pituitary tumours in children different from adults 2) giant pituitary adenomas are more aggressive in children .