Childhood pituitary tumors, although rare, do occur. Such tumors are usually benign, that is, non-cancerous. However, because the pituitary gland is very important in helping to regulate the hormones of the body, even a small disruption can have serious effects on mood, on the ability to focus and concentrate, as well as on growth and overall maturation. Pituitary tumors can also cause symptoms due to pressure on other parts of the brain and may cause headaches, dizziness, or problems with vision.
In general, the symptoms seen with pituitary tumors are related to a disturbance in production of a specific hormone or group of hormones, and relate to the role the hormones play in maintaining health and development. The symptoms of pituitary tumors vary depending on the size and location of the tumor, and whether the tumor presses on other organs or affects the secretion of hormones. For instance, pituitary tumors may press on the optic nerve, causing problems with vision.
The symptoms of a pituitary tumor can range from simple common complaints such as listlessness or restlessness to more severe symptoms such as headaches, vomiting, or dizziness. One problem in determining whether or not a tumor is present is that every child has minor and relatively unimportant symptoms such as restlessness or headaches from time to time. Of course, when more distressing signs or multiple symptoms are seen, parents and doctors search for an explanation and more precise tests are recommended.
In older children or adolescents, other signs may be seen including problems with normal growth and development. For instance, sometimes young girls or boys, under age nine, experience a very early puberty, referred to as precocious puberty. This is caused by tumors that secrete luteinizing hormone (LH). Girls may develop breasts, have pubic hair, and begin menstruation. Boys may find their genitals enlarging and facial and pubic hair beginning to grow. Tumors that secrete follicle stimulating hormone (FSH), in contrast, can retard sexual development in both sexes and stunt growth.
If the tumor limits the secretion of gonadotropin, it can affect the development and functioning of the ovaries and testes. Adolescent boys may fail to enter puberty or may lose facial or pubic hair and notice an effect on their genital size. Adolescent girls may also fail to enter puberty or may find their breasts smaller, some loss of pubic hair, and perhaps an interruption of menstruation.
Where secretion of adrenocorticotropic hormone (ACTH) is low, the child can experience low blood sugar, fatigue, and low blood pressure, which can cause dizziness when standing. On the other hand, with pituitary tumors that secrete ACTH, a variety of problems can result. These include stunted growth, delayed or stopped puberty, weight gain, acne, purple streaks in the skin, a round, red face, and a bulge of fat on the back of or below the neck. These tumors can also cause weakness, depression, or forgetfulness and trigger a sudden complete or partial loss of vision.
Some pituitary tumors can disrupt the function of the thyroid gland by secreting thyroid stimulating hormone (TSH). This in turn enlarges the thyroid, causing a visibly large lump in the neck known as a goiter. These tumors also cause nervousness, a rapid pulse, weight loss, excess eating and sweating, and a sensitivity to heat.
Pituitary tumors that limit the secretion of TSH can also affect a child in many ways, including making it harder to concentrate, tiredness, constipation, dry skin, and a sensitivity to cold. It may also cause girls to have irregular periods or not to menstruate at all.
Some pituitary tumors decrease the secretion of vasopressin, the hormone that triggers the kidneys reabsorption of water from urine. A lack of vasopressin can cause a great thirst, excess urination, voracious appetite accompanied by emaciation, loss of strength, and fainting.
Other pituitary tumors secrete an excess of the hormone prolactin. In girls who have gone through puberty, tumors that secrete the hormone prolactin can cause the production of breast milk and stop menstruation, while in post-pubertal boys they can cause impotence. An excess of prolactin can also delay or stop puberty in both sexes.
A pituitary tumor that limits the secretion of growth hormone (GH) can stunt the growth of children and cause low blood sugar, which can induce fainting, dizziness, anxiety, and intense hunger. Growth hormone-secreting tumors in growing children can boost growth excessively so that, if not treated, the children can grow unusually tall.
In adolescent children who have gone through puberty, and whose bones have stopped growing, excess GH can cause enlargement of their feet, hands, lips, nose, and jaw, a condition referred to as acromegaly. It also can foster excess perspiration and fatigue, a widening of the spaces between the teeth, furrows in the forehead, and weakness in the hands.
The most common type of pituitary tumor in children is due to growth of embryonic remnants in the area of the pituitary gland and is called craniopharyngioma. This tumor often disrupts vision by pressing on the optic nerve. Craniopharyngiomas also cause a lack of most pituitary hormones, prompting a combination of some of the symptoms previously described for tumors that induce a deficiency of single pituitary hormones.
Doctors can detect larger pituitary tumors on an X-ray, computerized tomography (CT) scan, or magnetic resonance imaging (MRI) scan. Many pituitary tumors, however, are too small to be seen on these images of the pituitary region of the brain. To diagnose these tumors, doctors try to detect the hormonal abnormalities with various tests. Often, blood or urine levels of specific hormones are measured within a few hours of giving the patient compounds known to stimulate or suppress production of the hormones.
For instance, sometimes patients are given a glucose tolerance test. After fasting overnight, the patient drinks a sugar solution, then has blood samples taken in which sugar or growth hormone levels are measured. Sometimes, in order to locate a very small tumor in the pituitary gland, an invasive procedure is required. This procedure is called inferior petrosal sinus sampling. A radiologist inserts special catheters from the groin veins into the vessels that drain the pituitary gland at the top of the neck, and draws blood for measurement of the hormone that the tumor secretes.
Doctors can successfully treat most pituitary tumors with microsurgery performed under the magnification of a surgical microscope, radiation therapy, surgery, drugs, or a combination of these treatments. Surgery is the treatment of choice for tumors that enlarge rapidly and threaten vision. The treatment plan for other pituitary tumors varies according to the type and size of the tumor.
Depending on each individual diagnosis, a physician can prescribe a wide variety of treatments. Sometimes treatments stimulate or compensate for missing hormones, others reduce the production of hormones. In some cases, medications must be taken on a daily basis.
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