The child initially is normal; manifestations similar to those seen in idiopathic pituitary growth failure gradually appear and progress.

When complete or almost complete destruction of the pituitary gland occurs, signs of pituitary insufficiency are present.

Atrophy of the adrenal cortex, thyroid, and gonads results in loss of weight, asthenia, sensitivity to cold, mental torpor, and absence of sweating.

Sexual maturation fails to take place or regresses if already present. There may be atrophy of the gonads and genital tract with amenorrhea and loss of pubic and axillary hair.

There is a tendency to hypoglycemia. Growth slows dramatically. Diabetes insipidus may be present early but tends to improve spontaneously as the anterior pituitary is progressively destroyed.

If the lesion is an expanding tumor, symptoms such as headache, vomiting, visual disturbances, pathologic sleep patterns, decreased school performance, seizures, polyuria, and growth failure may occur. Slowing of growth may antedate neurologic signs and symptoms, especially with craniopharyngiomas, but symptoms of hormonal deficit account for only 10% of presenting complaints. Evidence of pituitary insufficiency may first appear after surgical intervention. In children with craniopharyngiomas, visual field defects, optic atrophy, papilledema, and cranial nerve palsy are common.

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