Do Small Pituitary Lesions In Pediatric Patients Need Neurosurgical Monitoring?

Abstract

Introduction: Small, sub-centimeter pituitary lesions (PLs) are frequently found on brain imaging. However, there is little data on the surveillance outcome in the pediatric population. This report is a single institution case series of PLs and the outcomes from serial monitoring. Methods: A retrospective chart review was performed of 24 pediatric patients referred to neurosurgery for evaluation of PLs on MRI. Subjects were selected from electronic medical records. Demographics, MRI findings, referral reason, response to medical treatment, and development of new symptoms were recorded for each subject. Results: The majority of subjects were female (83.3%), with a median age of 8.7 years. Most had endocrine issues, including precocious puberty (33.3%), short stature (25.0%), and menstrual problems (12.5%). 62.5% of the lesions were less than 7mm in size, and 96% were less than 1cm. 77.8% of subjects saw improvement or resolution of their initial symptoms with medical management alone. No patients required surgical intervention. On average, subjects underwent follow-up MRIs every 7.5 months with a median of 3 MRIs per subject. 64.7% showed no interval change in size in serial MRIs. 23.5% showed improvement, and 11.8% showed worsening of the lesion. Subjects had a median of 3 MRIs and 4 visits to neurosurgery, with average neurosurgical follow-up of 1.89 years. Across the 55.24 patient-years of follow-up, two developed headaches attributed to migraines. Development of these symptoms was not significantly associated with radiographic evidence of lesion growth. Conclusion: Though the sample size was small, our data suggests that pediatric pituitary lesions, especially those sub-centimeter in size, are unlikely to develop into pathology requiring surgery. We believe that a new pituitary lesion should be evaluated by a neurosurgeon with at least one follow up image. If stable, the lesion is unlikely to become symptomatic.