title: Clinically non-functioning pituitary macroadenomas in the elderly.
abstract: 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.
authors.affiliation: Division of Endocrinology, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genova, Italy. patrizia.del.monte@galliera.it
authors.forename: Patrizia
authors.initials: P
authors.lastname: Del Monte
authors.forename: Luca
authors.initials: L
authors.lastname: Foppiani
authors.forename: Antonio
authors.initials: A
authors.lastname: Ruelle
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Andrioli
authors.forename: Roberto
authors.initials: R
authors.lastname: Bandelloni
authors.forename: Paolo
authors.initials: P
authors.lastname: Quilici
authors.forename: Camilla
authors.initials: C
authors.lastname: Prete
authors.forename: Ernesto
authors.initials: E
authors.lastname: Palummeri
authors.forename: Alessandro
authors.initials: A
authors.lastname: Marugo
authors.forename: Donatella
authors.initials: D
authors.lastname: Bernasconi
mesh_terms: 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