Division of Molecular Genetics, Department of Pediatrics, Columbia University Medical Center, New York, New York.
Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts.
J Clin Endocrinol Metab. 2019 Dec 1;104(12):5906-5912. doi: 10.1210/jc.2019-01252.
Pituitary lesions consistent with microadenomas are increasingly discovered by MRI. Sparse data are available on the long-term clinical and imaging course of such lesions in children.
The aim of this study was to define the clinical and imaging course of pituitary lesions representing or possibly representing nonfunctioning microadenomas in children to guide clinical management.
Retrospective observational study.
The clinical data warehouse at a tertiary care academic children's hospital was queried with the terms "pituitary" AND "microadenoma" and "pituitary" AND "incidentaloma." The electronic health records of the identified subjects were reviewed to extract data on the clinical and imaging course.
A total of 78 children had nonfunctioning pituitary lesions incidentally discovered during clinical care, of which 44 (56%) were reported as presumed or possible microadenomas. In the children with microadenoma (median age 15 years, interquartile range 2), a majority (70%) underwent imaging for nonendocrine symptoms, the most common being headache (n = 16, 36%). No significant increase in the size of the microadenoma or cysts or worsening of pituitary function was seen over the average clinical follow-up of 4.5 ± 2.6 years. Four cases of drug-induced hyperprolactinemia resolved with discontinuation of the offending medication.
Asymptomatic pituitary lesions representing cysts, microadenomas, or possible microadenomas follow a benign course in children. In the absence of new endocrine or visual symptoms, repeat MRI may not be needed, and if performed, should be done in no less than a year. When possible, it is prudent to discontinue hyperprolactinemia-inducing medications before imaging.
磁共振成像（MRI）越来越多地发现与微腺瘤一致的垂体病变。关于此类病变在儿童中的长期临床和影像学过程，数据稀少。
本研究旨在确定代表或可能代表儿童无功能微腺瘤的垂体病变的临床和影像学过程，以指导临床管理。
回顾性观察性研究。
在一家三级保健学术儿童医院的临床数据仓库中，使用“垂体”和“微腺瘤”以及“垂体”和“偶发瘤”这两个术语进行查询。对确定的研究对象的电子健康记录进行审查，以提取临床和影像学过程的数据。
共有 78 名儿童在临床护理中偶然发现无功能的垂体病变，其中 44 名（56%）被报告为推定或可能的微腺瘤。在患有微腺瘤的儿童（中位年龄 15 岁，四分位间距 2）中，大多数（70%）因非内分泌症状进行影像学检查，最常见的是头痛（n=16，36%）。在平均 4.5±2.6 年的临床随访中，未发现微腺瘤或囊肿的大小显著增加或垂体功能恶化。4 例药物诱导的高泌乳素血症在停用致病药物后得到缓解。
代表囊肿、微腺瘤或可能的微腺瘤的无症状垂体病变在儿童中具有良性过程。在没有新的内分泌或视觉症状的情况下，可能不需要重复磁共振成像，如果需要，应在不少于 1 年内进行。如果可能，在进行影像学检查之前，应谨慎停用引起高泌乳素血症的药物。
