Clinical Characteristics of Pediatric Patients With Sellar and Suprasellar Lesions Who Initially Present With Central Diabetes Insipidus: A Retrospective Study of 55 Cases From a Large Pituitary Center in China

Ji, Xin; Wang, Zihao; Wang, Wenze; Gao, Lu; Guo, Xiaopeng; Feng, Cheng; Lian, Wei; Deng, Kan; Xing, Bing

doi:10.3389/fendo.2020.00076

Cited by 9 publications

(5 citation statements)

References 43 publications

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“…Intracranial germ cell tumours comprise approximately 0.4%‐3% of all brain tumours 76 . They often arise at the neurohypophysis, explaining the high prevalence of DI in these tumours 77 ; DI can occur before the onset of other symptoms even when these tumours are not detectable by neuroimaging 78 . Pituitary abscesses are also rare, comprising less than 1% of all sellar lesions 79 .…”

Section: Discussionmentioning

confidence: 99%

Diabetes insipidus secondary to sellar/parasellar lesions

Angelousi

Mytareli

Xekouki

et al. 2021

J Neuroendocrinology

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Diabetes insipidus (DI) is a well‐recognised transient or permanent complication following transsphenoidal surgery for pituitary adenomas or other sellar/parasellar lesions. However, data regarding the prevalence of pre‐operative DI in sellar/parasellar lesions other than pituitary adenomas are scarce. We systematically reviewed the existing data for defining the prevalence of DI before any treatment in adult patients with sellar/parasellar lesions, excluding pituitary adenomas and metastatic lesions. In total, 646 patients with sellar/parasellar lesions presenting with DI at diagnosis were identified. The most common pathologies of sellar/parasellar lesions presenting with DI at diagnosis were lymphocytic hypophysitis (26.5%), craniopharyngiomas (23.4%), Langerhans's cell histiocytosis (18.9%) and Rathke's cleft cyst (12.7%), accounting for the vast majority (more than 80%) of these lesions. Overall, DI at diagnosis was found in 23.4% of all patients with sellar/parasellar lesions, albeit with a wide range from 10.6% to 76.7%, depending on the nature of the pathology. The highest prevalence of DI was found in less commonly encountered lesions namely germ‐cell tumours (76.7%), abscesses (55.4%) and neurosarcoidosis (54.5%), each accounting for less than 3% of all sellar/parasellar lesions. Most DI cases (68.8%) were associated with anterior pituitary hormonal deficiencies, in contrast to pituitary adenomas that rarely present with DI. The enlargement and enhancement of the pituitary stalk were the most common findings on magnetic resonance imaging besides the loss of the high signal of the posterior pituitary on T1‐weighted images. Resolution of DI spontaneously or following systemic and surgical management occurred in 22.4% of cases. Post‐operative DI, not evident before surgery, was found in 27.8% of non‐adenomatous sellar/parasellar lesions, and was transient in 11.6% of them. Besides distinctive imaging features and symptoms, early recognition of DI in such lesions is important because it directs the diagnosis towards a non‐adenomatous sellar/parasellar tumour and the early initiation of appropriate treatment.

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Section: Discussionmentioning

confidence: 99%

Diabetes insipidus secondary to sellar/parasellar lesions

Angelousi

Mytareli

Xekouki

et al. 2021

J Neuroendocrinology

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“…Analysis of diagnostic sub-intervals in patients with endocrinopathies as presenting symptoms showed a lengthy TI in those subjects presented with DI and thicken pituitary stalk on MRI: the "occult" sellar tumours were only recognized on biopsy with a latency of up to 58.5 months. In a recent retrospective study of 55 cases from a large pituitary centre in China, average duration of MRI follow-up was 21.5±21.2 months in this subset of patients 32 . While TI depends sometimes on unchangeable and unpredictable factors (e.g.…”

Section: Discussionmentioning

confidence: 86%

Implications of Deferred Diagnosis of Paediatric Intracranial Germ Cell Tumours

Partenope

Pozzobon

Weber

et al. 2022

Preprint

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AIMS This study analysed the clinical features of children with intracranial germ cell tumours (IC-GCTs) treated at two European centres. We retrospectively reviewed timelag between symptoms onset, clinic-radiological findings, diagnosis and outcomes. METHODS Symptoms at diagnosis were divided into four groups: 1)raised intracranial pressure (RICP); 2)visual impairment; 3)endocrinopathy; 4)other. Total diagnostic interval (TDI), defined as the interval between symptom onset (including retrospective recall of symptoms) and definitive diagnosis of IC-GCT, was calculated and compared to survival rates. RESULTS Our cohort included 55 children with a median follow-up of 78.9 months (0.5-249.9). The majority (63.6%) had germinomas and 10.9% were metastatic at diagnosis. IC-GCTs were suprasellar (41.8%), pineal (36.4%), bifocal (12.7%) or in atypical sites (9.1%). The most common presenting symptoms were related to RICP (43.6%); however, by the time of tumour diagnosis, 50.9% of the patients had developed endocrine dysfunctions. All pineal GCTs manifested with RICP or visual impairment. All suprasellar GCTs presented with endocrinopathies. TDI ranged between 0.25-58.5 months (median 4 months). Pineal GCTs had the shortest TDI (median TDI 1 month versus 24 months in suprasellar GCTs, p<0.001). TDI >6 months was observed in 47.3% of patients and was significantly associated with endocrine presenting symptoms. No statistically significant difference was found in progression-free survival and overall survival between patients with TDI >6 months and with TDI 6 months. CONCLUSION Approximately half of our patients had TDI >6 months, mostly with endocrine deficiencies as presenting symptoms. TDI >6 months was not associated with increased relapse rate or mortality.

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“…Analysis of diagnostic sub‐intervals in patients with endocrinopathies as presenting symptoms showed a lengthy TI in those subjects presented with DI and thicken pituitary stalk on MRI: the ‘occult’ sellar tumours were only recognized on biopsy with a latency of up to 58.5 months. In a recent retrospective study of 55 cases from a large pituitary centre in China, average duration of MRI follow‐up was 21.5 ± 21.2 months in this subset of patients 37 . While TI depends sometimes on unchangeable and unpredictable factors (e.g., size and location of tumour for biopsy), time from onset of symptoms until first MRI, that is, PI + HI, is clinically more relevant, because it gathers the importance of patient/family awareness (PI) with the suspicion of the clinician to make an early diagnosis (HI).…”

Section: Discussionmentioning

confidence: 90%

“…In a recent retrospective study of 55 cases from a large pituitary centre in China, average duration of MRI follow-up was 21.5 ± 21.2 months in this subset of patients. 37 While TI depends sometimes on unchangeable and unpredictable factors (e.g., size and location of tumour for biopsy), time from onset of symptoms until first MRI, that is, PI + HI, is clinically more relevant, because it gathers the importance of patient/family awareness (PI) with the suspicion of the clinician to make an early diagnosis (HI). HI in our cohort was modest and did not appear to contribute considerably to TDI.…”

Section: Discussionmentioning

confidence: 99%