Background: Pituitary adenomas (PAs) in the elderly, defined as people older than 65 years, represent less than 10% of all PAs. Because of increasing life expectancy and improving health care, diagnosis PAs in this age group is increasing with time. Age-related changes and associated diseases may significantly modify the clinical presentation in these patients, delaying the diagnosis of PAs.
Objective: To analyse the clinical features of PAs in elderly patients in a study population from Castilla La Mancha (Spain).
Design: Retrospective observational study.
Methods: The study included 346 patients with a presumptive diagnosis of pituitary adenoma between 2000 and 2012. Review of medical records of elderly patients with PAs was carried out.
Results: 67 patients, 19.4% of whole PAs, were studied (62.7% women). Mean age was 73 years (range 6587). At presentation, visual impairment, headache and deficiency of ≧1 pituitary axes were detected respectively in 43.3, 47.6 and 50.8% of the patients with available data. There were statisti-cally significant differences in visual impairment (43.3% vs 16.3%, P<0.001), deficiency of ≧1 pituitary axes (50.8% vs 30.5%, P<0.001), incidental diagnosis (47.8% vs 14.9%, P<0.001) or pituitary apoplexy (10,4% vs 1%, P<0.001) between elderly and younger patients at presentation. 59 (88,1%) out of 67 patients had macroadenomas whereas 8 (11.9%) had microadenomas. Mean size of PAs in elderly patients was significantly greater than non elderly patients (23.9±12±0 mm vs 15.2±12.4 mm, P<0.001). 58 (86.8%) were non-functioning pituitary adenomas, 3 (4.5%) prolactinomas, and 6 (8.9%) GH-secreting adenoma. There was none ACTH secreting adenoma.
Conclusions: The proportion of elderly patients in our study is higher than in other studies. Our data show that there are age-related differences in PAs clinical features at diagnosis. Visual impairment, hypopituitarism, incidental diagnosis, pituitary apoplexy and larger size are more frecuent features in elderly patients than in their younger counterparts. Most of PAs in elderly patients are macroadenomas and clinically non-functioning.