ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 63 P242 | DOI: 10.1530/endoabs.63.P242

Pituitary tumors diagnosed in octogenarians - clinical implications

Nelson Cunha1,2, Leonor Gomes1,2, Isabel Paiva1, Lúcia Fadiga1, Diana Catarino1, Diana Silva1, Joana Guiomar1, Inês Vieira1, Mariana Lavrador1 & Margarida Bastos1,2

1Department of Endocrinology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; 2Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal.

Introduction: The aging population brought new challenges in several diseases. Pituitary tumors are usually not related with elderly, although the rise in life expectancy has allowed its diagnosis in unusual age groups.

Aim: To describe the pituitary tumors diagnosed in patients with age ≥ 80 years

Methods: Retrospective observational study which included 23 patients with pituitary tumors with age ≥ 80 years observed in consultation between October of 2017 and October of 2018. Data were collected from clinical registry.

Results: 57% were female (n=13), with a mean age at diagnosis of 83.3±2.2 years. 78% were considered incidentalomas (n=18) and the clinical diagnosis were: 78% clinically non-functional tumors (CNFT) (n=18), 17% prolactinomas (PRLoma) (n=4), 4% acromegaly (ACRO) (n=1). 91% were macroadenomas (n=21) with mean length of 2.7±1.1 cm, 95% with suprasselar extension, 45% with extension to cavernous sinus and 15% with infrasselar extension. 60% of patients presented neurological symptoms, 50% ophthalmological symptoms and 10% endocrinological symptoms. 70% of patients were diagnosed with some degree of hypopituitarism, wherein 13% presented panhypopituitarism (n=3). Visual field evaluation was performed in only 44% of patients due to limitations related with age and, in these, visual field defects were observed in 90% of patients (n=9). Transsphenoidal surgery was performed in four patients (13%) with CNFT and the immunochemistry was consistent with gonadotroph adenomas. Three patients presented improvement of visual evaluation and no improvement was seen in endocrinological function. Thirteen patients (57%) were treated with dopamine agonists (8 CNFT, 4 PRLomas, 1 ACRO), 54% with bromocriptine with a mean dose of 2.5 mg/day and 46% with cabergoline with a mean dose of 1mg/week, with improvement of hypogonadism in two patients (1 PRLoma, 1 CNFT). Acromegaly patient was also treated with lanreotide. During follow-up two patients developed corticotroph insufficiency and four patients deceased.

Conclusion: These data show that majority of pituitary tumors diagnosed in octogenarians were clinically non-functional macroadenomas, identified in imaging exams performed due to other clinical reasons. Despite the incidental diagnosis, 80% of patients presented some kind of neurological, ophthalmological or endocrinological symptoms. Just five patients (22%) had clinically functional tumors (4 prolactinomas and 1 acromegaly) and no Cushing disease was diagnosed. The presence of non-specific symptoms and its difficult appreciation associated with high prevalence of some degree of hypopituitarism shows the relevance of the diagnosis of pituitary tumors in this age group to do the prompt start of substitutive treatment in order to avoid potentially fatal outcomes.

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