Pituitary Adenomas in Childhood S.K. Singh and Rohit Aggarwal Department of Endocrinology & Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi Abstract. Pituitary adenomas are common tumors composed of adenohypophysial cells.Although they usually arise in the sella turcica, they may occasionally be ectopic. Pituitary adenomas are rarely diagnosed in. childhood and adolescence, but their mass effect and endocrine abnormalities can compromise both quality and length of life. Many signs or symptoms of pituitary adenoma, complained of in adulthood, not became evident during adolescence, suggesting true prevalence of this tumor in teenagers is higher than expected. Pititury adenoma occuring during adolescence are associated with features or therapeutic needs sometimes different from those occuring in adulthood. At the onset of disease, delay in growth was rarely observed in teenagers with pituitary adenomas. Many girls complain of oligoamenorrhoea and galactorrhoea, while headache and delay in pubertal development are the most commons features in boys. Hypopituitarism is occasionally encountered in adolescence. Early diagnosis and appropriate choice of therapy are necessary to avoid permanent endocrine complications of disease and its treatment. [Indian J Pediatr 2005; 72 (7) : 583-591] E-maih sksendocrine@yahoo.com Key words : Pituitary adenoma; Hypopituitarism; Adolescence Pituitary adenomas are common tumors composed of adenohypophysial cells commonly arising in the sella turcica but occasionally ectopic. Pituitary adenomas are the most common cause of pituitary disease in adults but less common in children, becoming increasingly more frequent during adolescent years.1 The estimated incidence of pituitary adenoma in children is still unknown since most published series included patients with onset of symptoms before the age of 20 years as pediatric patients. 2 Pituitary adenomas constitute less than 3% of supratentorial tumors in children 3 and 2.3-6% of all pituitary tumors treated surgically. 4 The average annual incidence of pituitary adenoma in children has been estimated to be 0.1/ million, s Among all supratentorial tumors treated during a 25-year period, pituitary adenoma was diagnosed in only 1.2% of children, f' Pituitary carcinomas are rare in adults and extremely rare in children. 7 Experience at our centre, which is a tertiary care hospital, cases of pituitary adenoma in childhood and adolescent are limited. This is largely on account of lack of early diagnosis and late presentation to the neurosurgical of our hospital. Majority of the cases with presentation of non- functioning pituitary adenoma were craniophyrangioma. They presented with headache, delayed growth and puberty and occasionally with polyuria and polydipsia suggestive of diabetes inspidius. Six patients had hamartomas on MRI in pituitary stalk (Fig. 1). One male Correspondenceand Reprint requests : Prof. S.K.Singh, Professor and Head, Department of Endocrinology& Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005 (India). in and two females presented with features of isosexual precocious puberty before eight years of age. We had five patients of ACTH producing Cushing disease. All patients presented with typical centripetal obesity, weight gain, moon facies, proximal weakness and amenorrhoea. Basal cortisol and dexamethasone suppression test revealed Cushing's disease. MRI of putuitary was normal. Three patients treated with ketoconazole and hydrocortisone (Block Replace therapy) and referred to higher institute Fig 1. MRI pituitary, Arrow shows hamartamatous tissue Indian Journal of Pediatrics, Volume 72--July, 2005 583