Hypothalamic-Pituitary Lesions in Pediatric Patients: Endocrine Symptoms Often Precede Neuro-Ophthalmic Presenting Symptoms

• Published in: The Journal of pediatrics 2012-11, Vol.161 (5), p.855-863.e3
• Main Authors: Taylor, Melissa, MD, Couto-Silva, Ana-Claudia, MD, Adan, Luis, MD, PhD, Trivin, Christine, PhD, Sainte-Rose, Christian, MD, Zerah, Michel, MD, Valteau-Couanet, Dominique, MD, Doz, François, MD, Chalumeau, Martin, MD, PhD, Brauner, Raja, MD, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Biological and medical sciences; Brain Neoplasms - complications; Brain Neoplasms - diagnosis; Child; Child, Preschool; Cohort Studies; Endocrine System Diseases - complications; Endocrine System Diseases - diagnosis; Female; General aspects; Glioma - complications; Glioma - diagnosis; Humans; Hypothalamic Neoplasms - complications; Hypothalamic Neoplasms - diagnosis; Hypothalamo-Hypophyseal System - physiology; Hypothalamus - pathology; Infant; Infant, Newborn; Male; Medical sciences; Pediatrics; Pediatrics - methods; Pituitary Gland - pathology; Pituitary Neoplasms - complications; Pituitary Neoplasms - diagnosis; Retrospective Studies; Time Factors; Vision Disorders - complications; Vision Disorders - diagnosis
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2012.05.014

Objective To evaluate whether analyses of clinical and endocrine presenting symptoms could help to shorten the time to diagnosis of hypothalamic-pituitary lesions in children. Study design A retrospective, single-center, cohort study of 176 patients (93 boys), aged 6 years (range, 0.2-18 years), with hypothalamic-pituitary lesions was performed. Results The lesions were craniopharyngioma (n = 56), optic pathway glioma (n = 54), suprasellar arachnoid cyst (n = 25), hamartoma (n = 22), germ cell tumor (n = 12), and hypothalamic-pituitary astrocytoma (n = 7). The most common presenting symptoms were neurologic (50%) and/or visual complaints (38%), followed by solitary endocrine symptoms (28%). Precocious puberty led to diagnosis in 19% of prepubertal patients (n = 131), occurring earlier in patients with hamartoma than in patients with optic-pathway glioma ( P < .02). Isolated diabetes insipidus led to diagnosis for all germ-cell tumors. For 122 patients with neuro-ophthalmic presenting symptoms, the mean symptom interval was 0.5 year (95% CI, 0.4-0.6 year), although 66% of patients had abnormal body mass index or growth velocity, which preceded the presenting symptom interval onset by 1.9 years (95% CI, 1.5-2.4 years) ( P < .0001) and 1.4 years (95% CI, 1-1.8 years) ( P < .0001), respectively. Among them, 41 patients were obese before diagnosis (median 2.2 years [IQR, 1-3 years] prior to diagnosis) and 35 of them had normal growth velocity at the onset of obesity. The sensitivity of current guidelines for management of childhood obesity failed to identify 61%-85% of obese children with an underlying hypothalamic-pituitary lesion in our series. Conclusions Endocrine disorders occurred in two-thirds of patients prior to the onset of the neuro-ophthalmic presenting symptom but were missed. Identifying them may help to diagnose hypothalamic-pituitary lesions earlier.