The Natural History of Non-Functioning Pituitary Adenomas (PAs) in Children Treated with Growth Hormone (GH): A Case Series

Presentation Number: SAT 415
Date of Presentation: April 1st, 2017

Nicholas Krasnow*, Owen Bersot, Winston Weiler, Bradley Pogostin, James Haigney, Marion Kessler, Michael Tenner and Richard A Noto
New York Medical College, Valhalla, NY

Abstract

Background: The progression of PAs and the effect of GH treatment has, to our knowledge, not been investigated.

Objective: To show longitudinally the change in volume (Vol) and percentage of the gland occupied (POGO) of nonfunctioning PAs in children treated with GH.

PTS/Methods: Children identified to have a PA who underwent post-contrast MRI with 1-2mm spatial resolution at the Div. of Neuroradiology at NYMC between 2007-16 were considered for inclusion. 16 patients (PTS) were identified who met these criteria. We excluded 8 PTS without follow-up (f/u) MRIs, 3 with functioning adenomas, and 1 with hydrocephalus. The 4 included PTS had nonfunctioning incidental PAs and were treated for GHD with GH. For those included, ages ranged from 4-12 YRs at baseline (mean 9.23±3.32YRs, median (MD) 10.65 YRs). Time between scans ranged from .41-2.24 YRs (mean .98±.49 YRs, MD .96 YRs). Number of scans ranged from 2-9 (mean 5.5±2.89, MD 5.5). Pituitary (Pit) and PA Vols were calculated with the ellipsoid formula (LxWxH/2).The POGOs of the PAs were calculated as PA Vol/Pit Vol x 100. PAs with an initial width 10 mm were classified as a macroadenoma (MAAD), and those with a width <10 mm were classified as a microadenoma (MIAD).

Results: 2 PTS were found to have a MIAD, and 2 PTS were found to have a MAAD. PA Vol increased in 2 PTS and decreased in 2 PTS. One MIAD resolved. POGO decreased in 3/4 PTS. Change in PA Vol between f/u ranged from -52.0-68.4mm3 with a mean of 2.72±32.41mm3 (MD 3.69mm3). Rate of PA growth ranged from -114.05-66.74mm3/YR with a mean of 1.31±41.88mm3/YR (MD 3.46mm3/YR). Change in POGO between f/u ranged from -15.25-12.80% with a mean of -2.10±8.09% (MD -2.53%). Rate of change (RC) in POGO ranged from -27.25-14.58%/YR with a mean of -3.01±10.63%/YR (MD -2.85%/YR). For the MIADs, change in PA Vol between f/u ranged from -25.77-40.24mm3 with a mean of 5.35±28.78mm3 (MD -.26mm3), rate of PA growth ranged from -40.87-45.85mm3/YR with a mean of 2.64±35.98mm3/YR (MD 0.21mm3/YR), change in POGO between f/u ranged from -14.20-12.80% with a mean of -1.42±9.47% (MD -3.11%), and RC in POGO ranged from -17.21-14.58%/YR with a mean of -1.97±11.12%/YR (MD -3.65%/YR). For the MAADs, change in PA Vol between f/u ranged from -51.96-68.40mm3 with a mean of 1.40±35.23mm3(MD 4.48mm3), rate of PA growth ranged from -114.05-66.74mm3/YR with a mean of .64±46.06mm3/YR (MD 7.97mm3/YR), change in POGO between f/u ranged from -15.25-12.53% with a mean of -2.44±7.75% (MD -2.25%), and RC in POGO ranged from -27.25-12.22%/YR with a mean of -3.53±10.84%/YR (MD -2.85%/YR).

Conclusion: Pediatric PAs demonstrate variable changes in size. We found minimal differences between the progression of MIADs and MAADs. POGO tended to decrease, so Pit growth outpaced PA growth. The variable growth during GH therapy suggests that GH plays no role in the evolution of PAs. We ask any investigator with similar PTS to contact us to develop a comprehensive database.

 

Nothing to Disclose: NK, OB, WW, BP, JH, MK, MT, RAN