ESPE Yearbook of Paediatric Endocrinology

Clin Endocrinol (Oxf). 2021 Feb;94(2):269–276. doi: 10.1111/cen.14353. PMID: 33098093.

Every clinician encounters sometimes tricky incidentalomas, i.e., non-symptom-related imaging findings that are a consequence of increased availability and resolution of radiologic imaging.

This study evaluated pediatric pituitary incidentalomas (PIs). Pituitary microadenomas, which are frequently encountered in adults, were rare in children. Any PI was detected in 22:1000 pediatric patients screened by any MRI protocol that including the sellar region, and the incidence was higher in older children. The most common pediatric PIs were Rathke’s cleft cysts (67.7%), followed by cystic lesions (19.4%). Only 12.9% of pediatric PIs were microadenomas.

The only endocrine abnormality found in the microadenoma patients (n=7) was mild hyperprolactinemia (although endocrine investigations were available only in n=4), which suggests that the adult microadenoma investigation strategy is valid also for pediatric patients: hence, all patients should be screened for hyperprolactinemia, and additional ACTH and GH axis evaluation is encouraged, especially if clinical suspicion. The study does not give a direct answer for how pediatric patients with PIs should be followed up. However, the most frequent pediatric PIs, Rathke’s cleft cysts and pituitary cystic lesions, rarely grow in size.