Visual dysfunction and hypopituitarism at presentation in a large cohort with non-functioning pituitary adenomas

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 88-111-Cushing's Disease & Non-Functioning Hypothalamus-Pituitary Tumors
Clinical
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-108
Harriet Pearce1, Gabriella Bugg1, Michael William O'Reilly*2, Rosalind Mitchell3, Alan Johnson4, Neil John Gittoes5, Andrew Alan Toogood6 and John Ayuk7
1Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom, 2University of Birmingham, Birmingham, United Kingdom, 3Queen Elizabeth Hospitals Birmingham, Birmingham, United Kingdom, 4University Hospitals Birmingham, Birmingham, United Kingdom, 5Queen Elizabeth Hospital, Birmingham, United Kingdom, 6University Hospitals Birmingham, Solihull, United Kingdom, 7University Hospital Birmingham, Birmingham, United Kingdom
Introduction:

Non-functioning pituitary adenomas (NFPAs) may present with signs and symptoms of hypopituitarism, compressive symptoms due to tumour expansion or may be an incidental diagnosis. We aimed to determine presentation patterns as well as prevalence of visual dysfunction and hypopituitarism in a large cohort with newly-diagnosed NFPAs at a tertiary centre.

Methods:

We conducted a retrospective review of electronic data on all new patients attending the medical or surgical pituitary clinic at Queen Elizabeth Hospital Birmingham with a diagnosis of NFPA 2009-2012.  Patients were identified by the informatics department. Electronic notes were reviewed to determine pattern of presentation, preoperative endocrine function and prevalence of visual disturbance in a newly-diagnosed population.

Results:

Complete data was available on 106 patients (57.5% male, mean age 58.4±15.3 years). Thirty-nine patients (37.9%) presented with visual loss, 10 (9.7%) with chronic headache, 13 (12.6%) with evidence of hypopituitarism, and 11 (10.5%) with pituitary apoplexy; 30 (29.1%) were detected incidentally on imaging performed for separate indications. On pituitary imaging 12 (11.3%) tumours were intrasellar, 35 (33%) had a suprasellar component, 47 (44.3%) had suprasellar extension with chiasmal compression and 12 (11.3%) invaded the cavernous sinus or parasellar region. Pituitary function was normal in 46.6% of patients; single hormone deficiency, multiple deficiencies and panhypopituitarism were observed in 22.3%, 12.6% and 18.4% respectively. Tumours detected incidentally had a higher prevalence of intact pituitary function compared to those with other presentations (68.9% v 39.6%, p=0.03). Normal pituitary function was more commonly observed in intrasellar compared to more extensive lesions (75% v 42.8%, p=0.01).  Formal preoperative visual field testing was performed in 80.6% of patients; field defects were identified in 57 cases (54.3%). Visual field testing was performed in 50 of 57 patients (87.7%) with lesions causing chiasmal compression, cavernous sinus invasion or parasellar extension.

Conclusion:

NFPAs have a heterogeneous presentation pattern and many are diagnosed incidentally. Over half of patients have at least one preoperative pituitary hormone deficiency. Endocrine function is more likely to be preserved in incidental lesions and those confined to the sella. All patients with suprasellar or invasive tumours must have preoperative visual assessment.

Nothing to Disclose: HP, GB, MWO, RM, AJ, NJG, AAT, JA

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