Babiker Amir, Idris Amani, Aldawsari Mohammed, Abu Abah Moath, Alaqeel Bothainah, Almotawa Asim, Masuadi Emad, AlShaikh Adnan, Azzubi Moutasem, Al Dubayee Mohammed, Al Alwan Ibrahim, Maghnie Mohamad
King Abdullah Specialized Children's Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Saudi Arabia.
Int J Pediatr Adolesc Med. 2022 Dec;9(4):196-202. doi: 10.1016/j.ijpam.2022.11.001. Epub 2022 Dec 21.
Post-operative pituitary insufficiency (PI) occurs in children with supra-tentorial tumors (STT) because of surgery or the mass effect of the tumor. We assessed the prevalence and clinical characteristics of STTs and predicted postoperative PI in our patients.
This retrospective cohort study included children who underwent surgery for STT in two tertiary hospitals in Saudi Arabia (2009-2019). We focused on clinical, radiological, and histopathological features of STTs. We also used a linear regression model to predict post-operative PI.
The study included 55 children (1-18 years, mean: 9.5 ± 4.9 years, 32 [54%] females) with an initial presentation of STT that required surgery excluding recurrent episodes. The calculated period prevalence of STT was 18.2%, and the prevalence of postoperative PI was 58.2% (n = 32/55). The most common symptoms were headache and visual disturbances, and 20% patients had preoperative symptoms of PI. Baseline preoperative investigations for PI were performed in 60% of patients, and dynamic tests were conducted in only seven patients. A residual cortisol deficiency was presumed in 24 (43.7%) patients and 18 (32.7%) patients who developed central diabetes insipidus (DI) post-operatively. Overall, the brain imaging correlated well with the histopathological diagnosis (kappa = 0.48; < .001). Craniopharyngioma (n = 15/55, 27.3%) was the commonest STT. Predictive factors for a postoperative residual PI included age (10.9 ± 4.8 years; p-value = .027), female gender (p-value = .016 [OR = 8.31; 95% CI (1.48-46.71)], presentation with headache ( value = .039 [OR = 9.27; 95% CI (1.12-76.72)]), and visual disturbances (p-value = .044 [OR = 5.07; 95% CI (1.04-24.61)].
STTs commonly occurred in our study population, and females were more prone to develop a residual PI. On-time surveillance of an intact endocrine system during the perioperative period is essential for the prediction and early management of PI.
幕上肿瘤（STT）患儿术后可因手术或肿瘤的占位效应而发生垂体功能减退（PI）。我们评估了STT的患病率和临床特征，并对我们的患者术后PI进行了预测。
这项回顾性队列研究纳入了在沙特阿拉伯两家三级医院接受STT手术的儿童（2009 - 2019年）。我们重点关注STT的临床、影像学和组织病理学特征。我们还使用线性回归模型预测术后PI。
该研究纳入了55名儿童（1 - 18岁，平均：9.5 ± 4.9岁，32名[54%]为女性），最初表现为需要手术治疗的STT，不包括复发情况。计算得出的STT期间患病率为18.2%，术后PI患病率为58.2%（n = 32/55）。最常见的症状是头痛和视力障碍，20%的患者术前有PI症状。60%的患者进行了PI的基线术前检查，仅7名患者进行了动态试验。24名（43.7%）患者和18名（32.7%）术后发生中枢性尿崩症（DI）的患者被推测存在残余皮质醇缺乏。总体而言，脑成像与组织病理学诊断相关性良好（kappa = 0.48；< 0.001）。颅咽管瘤（n = 15/55，27.3%）是最常见的STT。术后残余PI的预测因素包括年龄（10.9 ± 4.8岁；p值 = 0.027）、女性性别（p值 = 0.016 [OR = 8.31；95% CI（1.48 - 46.71）]）、以头痛为表现（p值 = 0.039 [OR = 9.27；95% CI（1.12 - 76.72）]）和视力障碍（p值 = 0.044 [OR = 5.07；95% CI（1.04 - 24.61）]）。
在我们的研究人群中STT常见，女性更容易发生残余PI。围手术期对完整内分泌系统进行及时监测对于PI的预测和早期管理至关重要。
