An Investigation of Pituitary Tumors and Related Hypothalmic Disorders

Study Overview
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Brief Summary
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There is a variety of tumors affecting the pituitary gland in childhood; some of these tumors (eg craniopharyngioma) are included among the most common central nervous system tumors in childhood. The gene(s) involved in the pathogenesis of these tumors are largely not known; their possible association with other developmental defects or inheritance pattern(s) has not been investigated. The present study serves as a (i) screening/training, and, (ii) a research protocol. As a screening and training study, this protocol allows our Institute to admit children with tumors of the hypothalamic-pituitary unit to the pediatric endocrine clinics and wards of the NIH Clinical Center for the purposes of (i)<TAB>training our fellows and students in the identification of genetic defects associated with pituitary tumor formation, and (ii)<TAB>teaching our fellows and students the recognition, management and complications of pituitary tumors As a research study, this protocol aims at (i)<TAB>developing new clinical studies for the recognition and therapy of pituitary tumors; as an example, two new studies have emerged within the context of this protocol: (a) investigation of a new research magnetic resonance imaging (MRI) tool and its usefulness in the identification of pituitary tumors, and (b) investigation of the psychological effects of cortisol secretion in pediatric patients with Cushing disease. Continuation of this protocol will eventually lead to new, separate protocols that will address all aspects of diagnosis of pituitary tumors and their therapy in childhood. (ii)<TAB>Identifying the genetic components of pituitary oncogenesis; those will be investigated by (a) studying the inheritance pattern of pituitary tumors in childhood and their possible association with other conditions in the families of the patients, and (ii) collecting tumor tissues and examining their molecular genetics. As with the clinical studies, the present protocol may help generate ideas for future studies on the treatment and clinical follow up of pediatric patients with tumors of the pituitary gland and, thus, lead to the development of better therapeutic regimens for these neoplasms.

Detailed Description
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Study Description:<TAB> This protocol aims to evaluate subjects with tumors of the hypothalamic pituitary unit to: identify genetic components of pituitary and hypothalamic oncogenesis, to develop new clinical studies for the recognition and therapy of pituitary tumors, and to investigate the psychological effects of cortisol secretion. Objectives:<TAB> Primary Objective: To collect peripheral blood DNA samples and tumor tissues and examine the molecular genetics of the specimens, in an effort to elucidate developmental pathways leading to pituitary gland oncogenesis and/or other defects. Secondary Objectives: To serve as a screening protocol for future studies on the treatment and clinical follow up of our patients with pituitary tumors; it is our hope that the protocol will continue to be a vehicle for the development of more related clinical studies. To evaluate the cognitive, psychological, and patient-reported health status of mental and social well-being and symptoms of adrenal insufficiency associated with Cushing syndrome in children with this disease. Endpoints: <TAB> Primary Endpoint: Molecular genetic testing, whole exome sequencing Secondary Endpoints: Pre-post treatment comparison of research variables related to pituitary/hypothalamic tumors and comorbidities. Cognitive, behavioral, psychological, and patient-reported outcomes

Official Title
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A Clinical and Genetic Investigation of Pituitary and HYPOTHALAMIC Tumors and Related Disorders

Conditions
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Panhypopituitarism, Gigantism/Acromegaly, Prolactinoma, Cushing Disease

Intervention / Treatment
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* Procedure: MRI
* Procedure: Tissue specimen collection


Participation Criteria
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Eligibility Criteria
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INCLUSION CRITERIA: Stated willingness to comply with all study procedures and availability for the duration of the study Male or female, aged 3 years to 70 years Evidence for the existence of a tumor of the hypothalamic-pituitary unit, as indicated by previously obtained imaging studies or biochemical investigation of the hypothalamohypophyseal function. Family members (any age) of patients with a family history of tumors and who will agree to participate in the DNA/linkage analysis study. Member of a kindred suspected of having an inherited form of pituitary neoplasia, as evidenced by results of a patient enrolled in this protocol. Ability of subject or Legally Authorized Representative (LAR)) to understand and the willingness to sign a written informed consent document. EXCLUSION CRITERIA: 1. Pregnancy.

Ages Eligible for Study
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Minimum Age: 3 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients with pituitary tumors or hypothalmic defects<br>Patients with pituitary tumors or hypothalmic defects | Procedure: MRI<br> <br> Procedure: Tissue specimen collection<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Molecular genetic testing, whole exome sequencing | To collect peripheral blood DNA samples and tumor tissues and examine the molecular genetics of the specimens, in an effort to elucidate developmental pathways leading to pituitary gland oncogenesis and/or other defects. | ongoing | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To investigate the usefulness of a new MRI of the pituitary gland | Comparison of MRI techniques to identify micro adenomas | completed | 
| To identify the clinical and genetic features of pituitary tumors by investigating their inheritance pattern and possible association with other conditions in the families of the patients, | Genetic studies of pituitary and hypothalamic tumors or related disorders | ongoing | 
| To evaluate the cognitive, psychological, and patient-reported health status of mental and social well-being and symptoms of adrenal insufficiency associated with Cushing syndrome in children with this disease. | Descriptive study of cognitive, psychological, and patient-reported health status of mental and social well-being associated with Cushing and after treatment | ongoing | 
| to collect peripheral blood DNA samples and tumor tissues and examine the molecular genetics of the specimens, in an effort to elucidate developmental pathways leading to pituitary gland oncogenesis and/or other defects | Genetic studies of pituitary and hypothalamic tumors or related disorders | ongoing | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Developmental Defect, Oncogenesis, Evaluation and Management, Psychological, Cushing Disease, Natural History