Clinically non-functioning pituitary macroadenomas in the elderly.
OBJECTIVE
The aim of the present study was to evaluate the clinical presentation, characteristics and post-surgical outcome of non-functioning pituitary macroadenomas (NFPM) in elderly patients.


METHODS
27 patients (65-81 years; 13 Males, 14 Females) with NFPM (20-45 mm in diameter) were studied. The symptoms prompting neuroradiological studies were vision alterations in 52%, and dizziness, loss of memory, confusion, headache and depression in 29%; in 19% of patients, the disease was incidentally discovered during computed tomography (CT) or magnetic resonance imaging (MRI) for head trauma or cerebral ischemic attacks.


RESULTS
Endocrinological evaluation on diagnosis showed global anterior hypopituitarism in 33% and partial hypopituitarism in 37% of patients. Immunohistochemistry showed signs of neurosecretion in most NFPM (chromogranin-A in 55%, gonadotropins in 19%, ACTH in 3.7%). Ki-67 antigen expression was indicative of low proliferative activity. Surgery was highly effective in improving alterations in vision and compressive symptoms, but was unable to restore normal pituitary function in established hypopituitarism in most cases. Eight patients (31%) were free of disease on subsequent MRI (follow-up 1-6 years). In 18 (69%) patients, a post-surgical residue was present. Of these, 6 (33%) underwent radiotherapy in the following years, owing to an increase in the volume of the remnants, and six (33%) underwent additional surgical treatment, followed by radiotherapy for further signs of growth in two. In the remaining patients, a small intrasellar remnant was stable on yearly MRI.


CONCLUSIONS
in elderly patients, the development of hypopituitarism is often overlooked and the initial diagnosis of NFPM may be delayed. This can expose patients to the risks of unrecognized hypopituitarism and jeopardize post-surgical outcome.
Del Monte
Patrizia
P
Division of Endocrinology, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genova, Italy. patrizia.del.monte@galliera.it
Foppiani
Luca
L
Ruelle
Antonio
A
Andrioli
Giancarlo
G
Bandelloni
Roberto
R
Quilici
Paolo
P
Prete
Camilla
C
Palummeri
Ernesto
E
Marugo
Alessandro
A
Bernasconi
Donatella
D
D000236:Adenoma / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007018:Hypopituitarism / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D010903:Pituitary Gland, Anterior / Q000503:physiopathology; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome