Tumors located in the pituitary region are infrequent among childhood, primarily consisting of craniopharyngeomas or pituitary adenomas. Although pituitary adenomas are more prevalent in adults, they make up less than 3% of all supratentorial tumors in children. Unlike their adult counterparts, pediatric pituitary tumors (PPTs) are predominantly secreting tumors and associated with significant morbidity. Due to their rare occurrence and complex nature, PPTs have received limited research attention. Consequently, this comprehensive study aims to explore the epidemiological and clinicopathological characteristics of PPTs

This retrospective study examined a total of 124 patients aged <18 years, who underwent transsphenoidal surgery for pituitary region lesions between 2013 and 2023. Parameters assessed included age, gender, clinical hormone production, histopathological and radiographic parameters, surgical features, postoperative complications and recurrences rate.

Among a total of n=124 pediatric patients, 30.7% underwent surgery to treat histologically confirmed pediatric pituitary tumors (PPTs), with ACTH-secreting adenomas being the most prevalent at 17.5%. We observed an age-dependent distribution pattern among all pituitary lesions, with craniopharyngiomas most frequently occurring in patients under 10 years old, accounting for 67.8% of cases, followed by ACTH-secreting adenomas (7.14%) and chordomas (7.14%). However, in patients older than 10 years, PPTs were the most common pituitary lesions, comprising 36.6% of cases, with corticotrophic (20.4%) and lactotrophic (7.5%) adenomas being the most common subtypes among all PPTs. Importantly, patients with corticotrophic adenomas were significantly younger than those with prolactinoma (12.8 vs. 15.7 years, p=0.0123) and showed a male predominance (1.75:1), whereas prolactinoma occurred more frequently in females (1:2). There were no significant differences in recurrence rates among the various PPT subtypes (p=0.516).

The current study is one of the largest to date, that examined perioperative features of pediatric pituitary region lesions. The age-dependent distribution pattern highlightes the prominence of craniopharyngiomas in younger patients, whilte PPTs became increasingly prevalent in those older than 10 years with predominant corticotrophic and lactotrophic subtypes. This series contributes a better understanding of PPTs, shedding light on their demographic, clinical and histopathological features.