PITUITARY DISEASE IN ELDERLY PATIENTS

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 167-198-Hypothalamus-Pituitary Development & Biology
Basic/Clinical
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-168
Karina Danilowicz*1, Eugenia Ase1, Marcos Manavela1, Santiago Tobin1, Daniela Mana1, Santiago Gonzalez Abbati1 and Oscar Domingo Bruno2
1Hospital de Clínicas, Argentina, 2Hospital de Clinicas, Buenos Aires, Argentina
Frequency of pituitary adenomas in the elderly has increased raising the question of their optimal management. The objective of this retrospective study was to analyze the basal and follow-up data of a group of patients ≥65 y-o.

Among 1009 patients included in our pituitary registry, we analyzed 60 (5.9%). Mean age at diagnosis was 70.5, range 65 to 80. The reasons for evaluation were visual abnormalities 37.5% and incidental 30.3%. The final diagnosis was pituitary adenomas 53, 88.3% (non-functioning (NF) 31, acromegaly 11, prolactinomas 8, Cushing’s disease (CD) 3) and empty sella (ES) 4, craneopharyngioma 1, meningioma 1 and chordoma 1. The radiological evaluation showed a mass >1 cm in 75%. The evolution time before diagnosis was estimated in <1 year in 51% and ≤5 in 42.8%. On clinical examination hypertension was found in 43%, diabetes 25.9%, dyslipidemia 33.3% and hyponatremia 9.1%. The laboratory evaluation showed central hypogonadism (CH) in 68.1% (n=47), GH deficiency (GHD) 43.5% (n=23), central hypothyroidism (H) 29.4% (n=51), secondary hypoadrenalism (IA) 29.4% (n=44) and hyperprolactinemia in 30.5% (n=59).

Surgery was performed in 33 (55%), with additional radiotherapy in 5. The time of hospitalization of those operated in our institution was 10.4 days (n=19). The ASA score was 2 in 13 and 3 in 6. The frequency of clinical complications was 57.9%. Post treatment CH was 87.9%, GHD 52.6%, H 40.5%, IA 48.6% (n=44) and transitory diabetes insipidous in 2.

Data on more than 6 months to 15 years of follow-up was obtained in 46. The patients with ES and meningioma showed no changes and the chordoma achieved control after 3 surgeries. 3/3 CD cured after surgery. Among the acromegalics, 4 underwent surgery, with remission in all. One denied any treatment. The other 4 received octreotide with control in 3. Seven prolactinomas were followed. Four received cabergoline with control of the tumor in 2/4. One was operated improving clinically and radiologically. Two received cabergoline and surgery, one was controlled, the other died because of a pituitary carcinoma. 21 NF were followed. Four received no treatment and stayed stable. After surgery 16/17 improved or maintained visual field defect. 14/16 persisted with a stable remnant, one showed no residual tumor and in one there was an increase in the tumoral rest.

We conclude that NF pituitary adenoma was the most frequent lesion, followed by acromegaly. Visual defect and incidental finding were the most common presenting symptoms. The majority of the lesions were >1cm. Time of hospitalization and frequency of complications after surgery were high. The majority of the patients had visual improvement or stabilization. Pituitary function worsened. Tumor control was particularly difficult in prolactinomas. Optimal therapeutic management in this group of patients should aim to control the disease preserving patient’s quality of life and visual defects.

Nothing to Disclose: KD, EA, MM, ST, DM, SG, ODB

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