Endocrine diagnosis and treatment of sellar lesions in pediatric age

Introduction: Sellar masses are a heterogeneous group of lesions, both in nature and management. Not all of them require surgery. Objectives: To describe the presenting symptoms of sellar masses and endocrine abnormalities occurring during follow-up. To emphasize the significance of endocrine assessment, and to identify lesions amenable to hormonal treatment. Patients and methods: A retrospective review of the records of children under 14 years of age referred to our center for sellar lesions during a period of 12 years. Data collected included sex, age, nature of lesion, clinical presentation, size, treatment, and endocrine abnormalities. Results: Forty-five patients (25 females) aged 7.2 +/- 4.1 years (range 0.25-13.5) were enrolled. Follow-up time was 6.2 +/- 3.7 years. Lesion nature was known in 39 cases, 4 of which were successfully treated at the Endocrinology Department: 3 prolactinomas (with dopamine agonist) and one thyrotroph cell hyperplasia (with levothyroxine). The most common presenting symptoms were neurological and/or visual (25/45), followed by endocrine conditions (13/45). Duration of endocrine and neuro-ophthalmic symptoms was 12.6 +/- 18.2 months and 2.6 +/- 4.9 months (p=0.012), respectively. Some endocrine conditions were found in 24/45 patients at the initial evaluation and in 37/45 patients at the end of follow-up. Conclusions: Management of sellar lesions requires a multidisciplinary effort. Endocrine tests are indispensable to identify lesions amenable to hormonal treatment. Endocrine disorders usually occurred before neurological and ophthalmological symptoms, and their identification may therefore allow for earlier diagnosis. Hormone assessment should be regularly performed during follow-up. (C) 2013 SEEN. Published by Elsevier Espana, S.L. All rights reserved.