[P3-200] Precocious Puberty and Brain Ischemia as a Manifestation of Pituitary Adenoma in a Child
Pediatric pituitary adenomas are rare in the pediatric age range and although usually benign, they can represent very challenging manifestation and management. We report a rare case of pituitary macroadenoma in a child presenting as precocious puberty and brain ischemia. A 9-year old boy was transferred to our pediatric intensive care unit with a working diagnosis of encephalitis from the previous health center. He had seizure with low grade fever, severe headache and decrease level of consciousness prior to admission. Upon physical examination the patient was disoriented, had left side hemiparesis and strabismus, his sexual development was Tanner stage IV for pubic hair and his testes were of adult size. Brain MRI revealed ischemic area on posterior lateral ventricle and anterior of right semiovale and corpus collosum. Pituitary gland was enlarged 18.8x14.4x6.2 mm, in accordance with pituitary adenoma. His cerebrospinal fluid, IGF 1 and growth hormon level are within normal limit. Patient received mannitol and dexamethasone to release the intracranial pressure. On the 3rd hospital day he regained consciousness and was discharged on 5th hospital day. Referral to pediatric endocrinologist and neurosurgeon was made.
Pituitary adenomas are extraordinarily rare in early childhood, their frequency increases during adolescence but they remain relatively rare tumors. Though rare, it is important to consider that pituitary adenoma may present with non-classical symptoms such as brain ischemia even in pediatric patients. Pediatricians need to do a thorough physical examination and open their mind for other possibilities to detect uncommon symptoms of an illness.
Pituitary adenomas are extraordinarily rare in early childhood, their frequency increases during adolescence but they remain relatively rare tumors. Though rare, it is important to consider that pituitary adenoma may present with non-classical symptoms such as brain ischemia even in pediatric patients. Pediatricians need to do a thorough physical examination and open their mind for other possibilities to detect uncommon symptoms of an illness.