ECE2022 Poster Presentations Pituitary and Neuroendocrinology (127 abstracts)
Pituitary adenomas in the elderly may be hiding behind age-related comorbidities
Sandra Pekic Djurdjevic 1,2 , Marko Stojanovic 1,2 , Emilija Manojlovic Gacic 1,3 , Mirjana Doknic 1,2 , Dragana Miljic 1,2 , Toplica Milojevic 4 , Mihailo Milicevic 1,4 , Aleksandar Stanimirovic 4 , Sandra Banjalic 5 , Zvezdana Jemuovic 2 , Marija Jovanovic 1,5 , Marina Nikolic Djurovic 1,2 , Danica Grujicic 1,4 , Vera Popovic 1 & Milan Petakov 1,2
1Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Clinic for Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Center, Belgrade, Serbia; 3Institute of Pathology, Belgrade, Serbia; 4Clinic for Neurosurgery, University Clinical Center, Belgrade, Serbia; 5Center for Radiology and Magnetic Resonance Imaging, University Clinical Center, Belgrade, Serbia
Background: Extended life expectancy and increase in neuroimaging availability, lead to increase in incidence of pituitary adenomas (PA) diagnosed after the age of 70. Recognition of PA in the elderly may be challenging and delayed due to symptoms overlapping with aging and comorbidities.
Objective: To investigate character and presenting symptoms of PA in patients diagnosed after the age of 70.
Methods: 105 patients (7.9%) with PA diagnosed after the age of 70 (58 males, 55.2%) were identified from the PA database (n=1332) of the Department of Neuroendocrinology for the past 17 years. Gender, age at diagnosis, tumor size, presenting signs and symptoms, presence of comorbidities and hyponatremia, functional type of PA and treatment modality were analyzed.
Results: Mean age at diagnosis was 74.5±0.4 years (range: 70-85). Thirteen patients (12.4%) were older than 80 years at diagnosis. Eighty-three patients (79%) had two or more comorbidities. Nonfunctional PA (NFPA) were significantly more prevalent (n=85; 81%) than functional PA (n=20; 19%; P<0.01). Eleven patients (10.5%) had acromegaly, six (5.7%) had prolactinoma, and three patients had corticotropinoma (2.9%). NFPA patients were older than those with functional PA (75.0±0.5 vs 72.7±0.6; P<0.05). Macroadenomas (n=97; 92.4%) were significantly more prevalent than microadenomas (n=8; 7.6%; P<0.01). Six patients with microadenoma had acromegaly. PA were significantly larger in males (28.6±1.8 vs 21.8±1.8 mm, P<0.01). Thirteen patients (12.4%) had gigantic adenomas (>4 cm), nine with NFPA. Prolactinomas (35.6±3.8 mm) were significantly larger than NFPA (25.8±1.4 mm) and acromegaly (13.1±2.9 mm), P<0.01. Presenting symptoms included: headache (n=52, 49.5%), visual impairment (often misinterpreted as cataract) (n=46, 43.8%), and cranial nerve palsies (n=11, 10.5%). Twelve patients (11.4%) had hyponatremia due to secondary hypocorticism. Dyslipidemia was diagnosed in 58 patients (55.2%). In 60 (57.1%) PA was detected fortuitously by imaging for reasons unrelated to pituitary disease, during investigation for non-specific neurological symptoms (gait, speech impairment, dizziness, falls, memory impairment, dementia, depression, loss of consciousness, deafness), headache, head trauma, cerebrovascular insults or subarachnoid hemorrhage. Hypopituitarism was confirmed as complete in 45 patients (42.9%), and partial in 15 patients (14.3%). Fifty-two patients (49.5%) underwent transphenoidal surgery, with no severe complications. Six patients (5.7%) with prolactinomas and six patients (5.7%) with acromegaly were medically treated.
Conclusion: The age-incidence for pituitary tumors shows a typical high risk in the elderly. Nonfunctioning macroadenomas are the most prevalent. Age-related comorbidities led to the late diagnosis of pituitary tumors in most elderly patients which accounted for the pituitary tumor size (macroadenomas in most).
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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