Endocrine Abstracts

Background: Pituitary adenoma (PA) is an under-investigated pathology in the elderly.

Objective: To review our case records of patients >70 years with PA, in order to evaluate presentation symptoms, hormonal results, and pituitary morphology.

Patients: 48 patients aged 70 years or older (21 females/27 males) were identified from the group of 610 patients with PA (7.9%) diagnosed at Neuroendocrine Unit, Clinic for Endocrinology, Belgrade, between 2005 and 2014. Median age in our group of elderly was 73 years (range 70–83).

Results: Thirty-six patients had nonfunctioning pituitary adenoma (NFPA), seven patients had acromegaly (ACRO), four patients had prolactinoma (PRL), and one patient had ACTH secreting PA. In majority of patients (n=44; 92%) macroadenoma was diagnosed (20–46 mm in diameter). Pituitary microadenoma was diagnosed in four patients (three ACRO and one NFPA). The commonest presenting symptoms were visual deterioration (n=23; 48%) and headache (n=22). Hyponatremia (due to secondary hypocorticism) was diagnosed in eight patients (17%). In five patients (all with hyponatremia and hypocorticism) loss of consciousness was the leading symptom. Other patients (20%) reported dizziness (n=5), loss of memory, confusion, and depression (n=5). In four patients (8%), the disease was incidentally discovered during CT or MRI for cerebral ischemic attacks. Endocrinological evaluation showed global anterior hypopituitarism in 18 patients (38%) and partial hypopituitarism in seven patients (15%; four patients had GH and gonadotropin deficiency and three patients had GH, gonadotropin, and TSH deficiency). Twenty-eight patients (58%; 24 NFPA, three ACRO, and one silent PRL) underwent transsphenoidal surgery, with no severe perioperative complications. Immunohistochemistry was performed in 12 patients (seven NFPA were positive for gonadotropins, one NFPA was GH sparsely granulated, and four NFPA patients were null cell PA). Ki-67 antigen expression was indicative of low proliferative activity.

Conclusion: In the last 10 years pituitary adenomas have been recognised more frequently in the elderly. Most were non-functioning pituitary macroadenomas which presented with visual deterioration and hypopituitarism. If hyponatremia is diagnosed in the elderly with PA, then it can be a life-threatening condition.