Pediatric sellar and parasellar lesions: a population-based cohort study of presentation, management, and endocrine outcomes

PURPOSE: Population-based studies describing the full clinical spectrum of pediatric sellar and parasellar lesions are scarce. Most available data derive from referral-based surgical or diagnosis-specific cohorts. We aimed to characterize presentation, lesion pathology, management, and long-term endocrine outcomes in a population-based cohort. METHODS: We conducted a retrospective, population-based cohort study of patients aged 18 years or younger diagnosed with sellar or parasellar lesions between 1976 and 2021 in a multicounty region. Clinical presentation, lesion characteristics, management, and endocrine outcomes were abstracted from medical records. Associations were evaluated by lesion type, lesion size (< 10 mm vs. ≥10 mm), and management approach. RESULTS: Among 104 patients, endocrine abnormalities at diagnosis differed by lesion type (p = 0.0004) and were most frequent among patients with pituitary adenomas. Endocrine dysfunction at presentation was more common with lesions ≥ 10 mm than with lesions < 10 mm (74.2% vs. 49.2%; p = 0.0217). Post-treatment endocrine abnormalities were also more common with lesions ≥ 10 mm (64.5% vs. 13.1%; p < 0.0001). Associations with treatment modality were descriptive and subject to confounding by indication. CONCLUSION: This population-based cohort captured a broad spectrum of pediatric sellar and parasellar disease, including uncommon lesions and conservatively managed cases. Endocrine morbidity was associated with lesion type and size, but clinically relevant abnormalities also occurred in smaller lesions, supporting endocrine evaluation based on clinical context and longitudinal surveillance.