TY - JOUR
T1 - The epidemiology and management patterns of pediatric pituitary tumors in the United States
AU - Castellanos, Luz E.
AU - Misra, Madhusmita
AU - Smith, Timothy R.
AU - Laws, Edward R.
AU - Iorgulescu, J. Bryan
N1 - Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.
PY - 2021/6
Y1 - 2021/6
N2 - Purpose: Hypothalamic-pituitary axis dysfunction and mass effect symptoms in the pediatric population can indicate a pituitary region tumor. Herein, we evaluate the epidemiology and management of this rare entity. Methods: Pediatric patients (≤ 21yo) who presented from 2004 to 2017 with a pituitary tumor were evaluated from the U.S. National Cancer Database. The distributions and management patterns of pituitary tumors were assessed by patients’ tumor type, age, sex, race/ethnicity, tumor size, and insurance status. Results: 19.7% of intracranial tumors in the pediatric population originated in the pituitary region. 7653 pediatric patients with pituitary region tumors were identified, 68.2% of whom were female, with the tumors predominantly occurring in early adolescence (46.9%) and late adolescence (34.8%). The majority of pediatric pituitary region tumors were pituitary adenomas (77.9%), followed by craniopharyngiomas (18.1%) and germ cell tumors (1.6%). Girls demonstrated higher proportions of pituitary adenomas across all ages than boys. Asian/Pacific Islander patients were independently more likely to present at younger ages (mean 13.9yrs) and with germ cell tumors than patients of other races/ethnicities. Only 5.5% of patients were uninsured (referent), but they were independently more likely to present at older ages (mean 17.9yrs) and less likely to undergo surgery than patients with private insurance (OR = 1.93, 95% CI = 1.47–2.52, p < 0.001) or Medicaid (OR = 1.51, 95% CI = 1.14–2.00, p = 0.004). Conclusion: Pituitary region tumors comprise a significant fraction of intracranial pediatric tumors, particularly in adolescent girls. The differential diagnosis of pituitary tumor types differed significantly by patients’ age, sex, and race/ethnicity. Uninsured patients were associated with delays in care and less surgical management.
AB - Purpose: Hypothalamic-pituitary axis dysfunction and mass effect symptoms in the pediatric population can indicate a pituitary region tumor. Herein, we evaluate the epidemiology and management of this rare entity. Methods: Pediatric patients (≤ 21yo) who presented from 2004 to 2017 with a pituitary tumor were evaluated from the U.S. National Cancer Database. The distributions and management patterns of pituitary tumors were assessed by patients’ tumor type, age, sex, race/ethnicity, tumor size, and insurance status. Results: 19.7% of intracranial tumors in the pediatric population originated in the pituitary region. 7653 pediatric patients with pituitary region tumors were identified, 68.2% of whom were female, with the tumors predominantly occurring in early adolescence (46.9%) and late adolescence (34.8%). The majority of pediatric pituitary region tumors were pituitary adenomas (77.9%), followed by craniopharyngiomas (18.1%) and germ cell tumors (1.6%). Girls demonstrated higher proportions of pituitary adenomas across all ages than boys. Asian/Pacific Islander patients were independently more likely to present at younger ages (mean 13.9yrs) and with germ cell tumors than patients of other races/ethnicities. Only 5.5% of patients were uninsured (referent), but they were independently more likely to present at older ages (mean 17.9yrs) and less likely to undergo surgery than patients with private insurance (OR = 1.93, 95% CI = 1.47–2.52, p < 0.001) or Medicaid (OR = 1.51, 95% CI = 1.14–2.00, p = 0.004). Conclusion: Pituitary region tumors comprise a significant fraction of intracranial pediatric tumors, particularly in adolescent girls. The differential diagnosis of pituitary tumor types differed significantly by patients’ age, sex, and race/ethnicity. Uninsured patients were associated with delays in care and less surgical management.
KW - Craniopharyngioma
KW - Epidemiology
KW - Pediatric
KW - Pituitary
KW - Pituitary adenoma
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U2 - 10.1007/s11102-020-01120-5
DO - 10.1007/s11102-020-01120-5
M3 - Article
C2 - 33433891
AN - SCOPUS:85099152899
SN - 1386-341X
VL - 24
SP - 412
EP - 419
JO - Pituitary
JF - Pituitary
IS - 3
ER -