Dual hormone-secreting pediatric pituitary adenoma: a case report and surgical management
Adenoma hipofisiario pediátrico con secreción dual de hormonas: reporte de caso y manejo quirúrgico
Armando Romero-Pérez, Ana Domínguez-Merino, Claudia Carrillo González, Luis Angel Haro-Santillan
Abstract
Pituitary adenomas are rare in pediatric populations representing only 2–6% of intracranial neoplasms, yet recent reports suggest an increasing incidence with more aggressive features, larger size, and earlier onset compared to adults. We present the case of a 10-year-old female with dual hypersecretion of growth hormone and prolactin who developed tall stature, galactorrhea, headache, visual disturbances, and neurological deficits. Magnetic resonance imaging revealed a sellar mass measuring 4.36 × 3.5 × 3.3 cm, and immunohistochemistry confirmed positivity for growth hormone and prolactin with a Ki-67 index of 2%. The patient underwent an initial craniofacial transcranial resection, but biochemical and radiological recurrence required a second surgery via endoscopic endonasal approach, achieving near-total removal of the tumor. This case illustrates the clinical complexity of pediatric pituitary adenomas with dual hormonal secretion, emphasizes the importance of multidisciplinary management and long-term follow-up, and highlights the advantages of endoscopic endonasal surgery in achieving superior resection rates and lower recurrence compared to traditional approaches.
Keywords
Resumen
Los adenomas pituitarios son neoplasias poco frecuentes en la población pediátrica, representando únicamente entre el 2 y el 6% de las neoplasias intracraneales; sin embargo, en los últimos años se ha reportado un incremento en su incidencia, con características más agresivas, mayor tamaño y aparición en edades más tempranas. Presentamos el caso de una paciente femenina de 10 años con hipersecreción dual de hormona de crecimiento y prolactina, que desarrolló talla alta, galactorrea, cefalea, alteraciones visuales y déficit neurológicos. La resonancia magnética evidenció una lesión selar de 4.36 × 3.5 × 3.3 cm, y la inmunohistoquímica confirmó hipersecreción de la hormona de crecimiento y prolactina, con un índice Ki-67 del 2%. La paciente fue sometida inicialmente a una resección transcraneal, pero presentó recurrencia bioquímica e imagenológica que requirió un segundo procedimiento quirúrgico por vía endoscópica endonasal, logrando una resección ≥95% de la masa tumoral. Este caso ilustra la complejidad clínica de los adenomas pituitarios pediátricos con secreción hormonal dual, resalta la importancia del abordaje multidisciplinario y del seguimiento prolongado, y subraya las ventajas de la cirugía endoscópica endonasal en términos de control tumoral y menor recurrencia frente a técnicas tradicionales.
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References
1. Komotar RJ, Starke RM, Raper DMS, Anand VK, Schwartz TH. Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of giant pituitary adenomas. Pituitary. 2012;15(2):150-9. https://doi.org/10.1007/s11102-011-0359-3. PMid:22038033.
2. Aguilar-Riera C, Clemente M, González-Llorens N, et al. Pituitary macroadenomas in childhood and adolescence: a clinical analysis of 7 patients. Clin Diabetes Endocrinol. 2023;9(1):5. https://doi.org/10.1186/s40842-023-00153-6. PMid:37908013.
3. Li X, Deng K, Zhang Y, et al. Pediatric pituitary neuroendocrine tumors: a 13-year experience in a tertiary center. Front Oncol. 2023;13:1270958. https://doi.org/10.3389/fonc.2023.1270958. PMid:38023185.
4. Colao A, Loche S. Prolactinomas in children and adolescents. In: Wass JAH, Shalet SM, editors. Oxford Textbook of Endocrinology and Diabetes. 2nd ed. Oxford: Oxford University Press; 2010. p.146–59.
5. Colao A, Pirchio R. Pituitary tumors in childhood. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext. South Dartmouth (MA): MDText.com, Inc.; 2000.
6. Korbonits M, Blair JC, Boguslawska A, et al. Consensus guideline for the diagnosis and management of pituitary adenomas in childhood and adolescence: Part 2, specific diseases. Nat Rev Endocrinol. 2024;20(5):290-309. https://doi.org/10.1038/s41574-023-00949-7. PMid:38336898.
7. Bogusławska A, Gilis-Januszewska A, Godlewska M, Nowak A, Starzyk J, Hubalewska-Dydejczyk A. Sex and age differences among patients with acromegaly. Pol Arch Intern Med. 2022;132(6). https://doi.org/10.20452/pamw.16232. PMid:35289160.
8. Daly AF, Cano DA, Venegas-Moreno E, et al. AIP and MEN1 mutations and AIP immunohistochemistry in pituitary adenomas in a tertiary referral center. Endocr Connect. 2019;8(4):338-48. https://doi.org/10.1530/EC-19-0027. PMid:30822274.
9. Jayant SS, Pal R, Rai A, et al. Paediatric pituitary adenomas: clinical presentation, biochemical profile and long-term prognosis. Neurol India. 2022;70(1):304-11. https://doi.org/10.4103/0028-3886.338667. PMid:35263901.
10. Li X, Tian C, Yao J. Clinical parameters and postoperative outcomes of pituitary adenomas in children: analysis according to size of adenomas and adopted surgical procedures. Mol Clin Oncol. 2024;21(6):94. https://doi.org/10.3892/mco.2024.2792. PMid:39484285.
11. Maiter D, Chanson P, Constantinescu SM, Linglart A. Diagnosis and management of pituitary adenomas in children and adolescents. Eur J Endocrinol. 2024;191(4):R55-R69. https://doi.org/10.1093/ejendo/lvae120. PMid:39374844.
12. Jayant SS, Pal R, Rai A, et al. Paediatric pituitary adenomas: clinical presentation, biochemical profile and long-term prognosis. Neurol India. 2022;70(1):304-11. https://doi.org/10.4103/0028-3886.338667. PMid:35263901.
13. Joshi KC, Kolb B, Khalili BF, Munich SA, Byrne RW. Surgical strategies in the treatment of giant pituitary adenomas. Oper Neurosurg (Hagerstown). 2024;26(1):4-15. https://doi.org/10.1227/ons.0000000000000896. PMid:37655871.
14. Pandey P, Ojha BK, Mahapatra AK. Pediatric pituitary adenoma: a series of 42 patients. J Clin Neurosci. 2005;12(2):124-7. https://doi.org/10.1016/j.jocn.2004.10.003. PMid:15749410.
Submitted date:
03/03/2026
Accepted date:
03/22/2026
Publication date:
04/28/2026
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