Endocrine Abstracts

Introduction: Pituitary adenomas in people over 65 represent less than 10% of all pituitary adenomas, 80% of which are non-functional. Somatotropic adenomas remain very rare. The interest of our study is to describe the clinical, paraclinical and therapeutic profile of cases of senile acromegaly.

Patients and methods: This is a retrospective study of four senile acromegaly patients followed in our endocrinology’s department.

Results: We report four cases of acromegalic patients, one woman and three men, respectively aged 75, 68, 65 and 69 at the time of diagnosis. Two had been diabetic and hypertensive for 05 years. The circumstances of discovery were a tumor syndrome in two patients, a dysmorphic syndrome in one patient and digestive symptoms secondary to a tumor process in another patient. The diagnosis was confirmed by elevated IGF1, a paradoxical GH response on OGTT and a disturbed GH cycle (two diabetics). Radiological exploration by pituitary MRI showed that it was a macroadenoma in 100% of cases with invasion of the cavernous sinuses and compression of the optic chiasm in two cases. The impact assessment revealed: corticotropic insufficiency (2 cases), bilateral visual field impairment (2 cases), moderate to severe sleep apnea syndrome (4 cases), hypertrophic heart disease (2 cases), arthropathy peripheral (2 cases), hypertriglyceridemia (1 case), a stenotic tumoral process inaugurating the disease in one patient and polyposis colon in two other patients, a multinodular goiter (1 case) and a TIRADS 2 nodule (2 cases). Therapeutically, the patient was treated surgically via the transphenoidal approach with simple post-operative follow-up. Given the operative risk and the non-motivation of the two other patients for surgery, they were put on a somatostatin analogue with a favorable outcome. The fourth patient was lost to sight.

Conclusion: Somatotropic adenomas in the elderly patients are rare, characterized by a diagnostic delay. Surgery, if possible, remains the treatment of choice for acromegaly in the elderly, but somatostatin analogues have also shown their effectiveness in the treatment of these patients.