Predictors of neoplastic disease in children with isolated pituitary stalk thickening. Issue 10 (14th May 2013)

• Record Type: Journal Article
• Authors: Robison, Nathan J.; Prabhu, Sanjay P.; Sun, Pengling; Chi, Susan N.; Kieran, Mark W.; Manley, Peter E.; Cohen, Laurie E.; Goumnerova, Liliana; Smith, Edward R.; Scott, R. Michael; London, Wendy B.; Ullrich, Nicole J.
• Is Part Of: Pediatric blood & cancer. Volume 60:Issue 10(2013:Oct.)
• Page Start: 1630
• Page End: 1635
• Publication Date: 2013-05-14
• Subjects: Tumors in children -- Periodicals; Blood -- Diseases -- Periodicals; Cancer in children -- Periodicals; 618.92
• DOI: 10.1002/pbc.24577
• Languages: English
• ISSNs: 1545-5009

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="pbc24577-sec-0001" sec-type="section"> <title>Background</title> <p>The significance of pituitary stalk thickening (PST) on magnetic resonance imaging (MRI) is often unclear. We evaluated presenting symptoms, MRI findings, clinical course, and outcome predictors of patients with PST.</p> </sec> <sec id="pbc24577-sec-0002" sec-type="section"> <title>Procedure</title> <p>We used a computerized search of the medical record from 1995 to 2008 to identify patients with PST without pituitary mass on MRI. Baseline and follow‐up MRIs were reviewed in a blinded fashion. Relevant clinical data were abstracted.</p> </sec> <sec id="pbc24577-sec-0003" sec-type="section"> <title>Results</title> <p>69 patients with reported PST and adequate imaging for review were identified; 42 met study criteria. Median age at first abnormal MRI was 13.6 years (range: 0.8–19.7); 43% were male. Median follow‐up was 3.4 years (range 0–12.8). Patients with diabetes insipidus (DI) were significantly more likely to have a neoplastic process than those without (<italic>P</italic> = 0.0008). Of 16 patients with DI, 8 (50%) had a neoplastic process, including germ cell tumor (n = 4), Langerhans cell histiocytosis (n = 3), and lymphoma (n = 1). Among patients with DI, 7 (44%) also developed anterior pituitary hormone dysfunction (APD), either at presentation or on pre‐biopsy follow‐up, including 6/8 patients with stalk neoplasm and only 1/8 patients with non‐neoplastic PST (<italic>P</italic> = 0.04). Twenty‐six patients presented without DI; none was found to have neoplasm of the stalk except one patient with craniopharyngioma. Progression of PST on follow‐up imaging was significantly associated with a subsequent neoplastic diagnosis (<italic>P</italic> = 0.04).</p> </sec> <sec id="pbc24577-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Patients with PST without DI are unlikely to have a neoplastic process. Among patients with DI, APD or progressive stalk increase over time are predictive of neoplasia. Pediatr Blood Cancer 2013;60:1630–1635. © 2013 Wiley Periodicals, Inc.</p> </sec> </abstract>