Spontaneous regression of paediatric pituitary lesions-report of 2 cases and literature review.

OBJECTIVE

Pituitary lesions are rare in the pediatric population. They consist of a heterogenous group of neoplasms including pituitary adenomas (PA) and Rathke cleft cysts (RCC). Their natural history, management strategies, and long-term outcomes are mostly extrapolated from adult experience. Neurosurgical intervention may be necessary for large and/or symptomatic lesions. Of note, the likelihood of their spontaneous regression is uncommon. We report 2 interesting cases of such a phenomenon for these lesions and discuss our findings in corroboration with current literature.

METHODS AND RESULTS

Two cases of spontaneous regression of pituitary lesions observed on serial neuroimaging are described. Based on their clinical history and radiological characteristics, the working diagnoses were that of a non-functioning PA and RCC, respectively. A systematic search of relevant publications in the English language is performed in PubMed and Google Scholar. Our findings show that there are 14 reported cases (including 1 of our patients) of spontaneous regression of non-functioning PA with good outcomes. Pertaining to RCCs, the limited evidence suggests that the incidence of their spontaneous regression is approximately 30%, similar to what is reported in the adult population. A separate discussion on the possible differential diagnosis of lymphocytic hypophysitis is also highlighted.

CONCLUSION

Pediatric pituitary lesions may present with unpredictable natural histories, as highlighted in our case examples. We advocate an extended period of follow-up by a cohesive multidisciplinary team. In meantime, collaborative efforts should focus on the establishing clinical practice guidelines to optimize the management of pituitary lesions in children.