A 9-year-old girl has experienced projectile vomiting, upset stomach, and a 9-lb weight loss over a 3-week period. After GI evaluation reveals no abnormalities, her pediatrician consults a pediatric neurologist, who orders an MRI that reveals a 1.6×1.6×1.0-cm homogeneously enhancing pituitary macroadenoma. The tumor elevates the optic chiasm minimally. A neuro-ophthalmologic evaluation demonstrates no evidence of optic neuropathy, cranial nerve palsy, or chiasmal syndrome.

Physical examination reveals weight loss and decreasing height velocity (1.53 cm/y) over the preceding 3 years, resulting in a drop from the 95th percentile to the 10th percentile in height.

CBC, blood chemistries, liver function tests, insulin-like growth factor (IGF-1), and cortisol values are normal. Prolactin is elevated at 94.7 ng/mL (4,117.4 pmol/L). Pituitary macroadenoma is diagnosed, and the patient is referred to the pediatric endocrinologist for preoperative evaluation.

A 23-month-old girl is referred to a pediatric neurologist for evaluation of generalized hypotonia and global developmental...

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