Division of Pediatric Endocrinology, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Pituitary and Neuroendocrine Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Pituitary. 2021 Jun;24(3):412-419. doi: 10.1007/s11102-020-01120-5. Epub 2021 Jan 12.
Hypothalamic-pituitary axis dysfunction and mass effect symptoms in the pediatric population can indicate a pituitary region tumor. Herein, we evaluate the epidemiology and management of this rare entity.
Pediatric patients (≤ 21yo) who presented from 2004 to 2017 with a pituitary tumor were evaluated from the U.S. National Cancer Database. The distributions and management patterns of pituitary tumors were assessed by patients' tumor type, age, sex, race/ethnicity, tumor size, and insurance status.
19.7% of intracranial tumors in the pediatric population originated in the pituitary region. 7653 pediatric patients with pituitary region tumors were identified, 68.2% of whom were female, with the tumors predominantly occurring in early adolescence (46.9%) and late adolescence (34.8%). The majority of pediatric pituitary region tumors were pituitary adenomas (77.9%), followed by craniopharyngiomas (18.1%) and germ cell tumors (1.6%). Girls demonstrated higher proportions of pituitary adenomas across all ages than boys. Asian/Pacific Islander patients were independently more likely to present at younger ages (mean 13.9yrs) and with germ cell tumors than patients of other races/ethnicities. Only 5.5% of patients were uninsured (referent), but they were independently more likely to present at older ages (mean 17.9yrs) and less likely to undergo surgery than patients with private insurance (OR = 1.93, 95% CI = 1.47-2.52, p < 0.001) or Medicaid (OR = 1.51, 95% CI = 1.14-2.00, p = 0.004).
Pituitary region tumors comprise a significant fraction of intracranial pediatric tumors, particularly in adolescent girls. The differential diagnosis of pituitary tumor types differed significantly by patients' age, sex, and race/ethnicity. Uninsured patients were associated with delays in care and less surgical management.
儿童下丘脑-垂体轴功能障碍和肿块效应症状可能表明存在垂体区域肿瘤。在此，我们评估了这种罕见实体的流行病学和治疗方法。
从美国国家癌症数据库中评估了 2004 年至 2017 年间患有垂体肿瘤的儿科患者。通过患者的肿瘤类型、年龄、性别、种族/民族、肿瘤大小和保险状况评估垂体肿瘤的分布和治疗模式。
儿童人群中 19.7%的颅内肿瘤源自垂体区域。共确定了 7653 例垂体区域肿瘤的儿科患者，其中 68.2%为女性，肿瘤主要发生在青春期早期（46.9%）和青春期晚期（34.8%）。大多数儿童垂体区域肿瘤为垂体腺瘤（77.9%），其次是颅咽管瘤（18.1%）和生殖细胞瘤（1.6%）。在所有年龄段中，女孩的垂体腺瘤比例均高于男孩。与其他种族/民族的患者相比，亚洲/太平洋岛民患者更有可能在更年轻的年龄（平均 13.9 岁）出现并患有生殖细胞瘤。仅有 5.5%的患者没有保险（参照组），但与有私人保险（OR=1.93，95%CI=1.47-2.52，p<0.001）或医疗补助（OR=1.51，95%CI=1.14-2.00，p=0.004）的患者相比，他们更有可能在较年长的年龄就诊，并且接受手术治疗的可能性较小。
垂体区域肿瘤构成了儿童颅内肿瘤的重要部分，尤其是在青春期少女中。垂体肿瘤类型的鉴别诊断在很大程度上取决于患者的年龄、性别和种族/民族。没有保险的患者与治疗延迟和手术管理减少有关。
