Abstract
Background and aims: 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 is-chemic attacks. Results: Endocrinological evaluation on diagnosis showed global anterior hypopituitarism in 33% and partial hypopituitarism in 37% of patients. Im-munohistochemistry 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 com-pressive symptoms, but was unable to restore normal pituitary function in established hypopituitarism in most cases. Eight patients (31%) were free of disease on subsequent MR (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 hy-popituitarism and jeopardize post-surgical outcome.
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References
Snyder PJ. Clinically nonfunctioning pituitary adenomas. Endocrinol Metab Clin North Am 1993; 22: 163–75.
Sassolas G, Trouillas J, Treluyer C, Perrin G. Management of non-functioning pituitary adenomas. Acta Endocrinol 1993; 129: 21–6.
Freda PU, Wardlaw SL. Diagnosis and treatment of pituitary tumors. J Clin Endocrinol Metab 1995; 80: 3–6.
Greenman Y, Ouaknine G, Veshchev I, Reider-Groswasser II, Segev Y, Stern N. Postoperative surveillance of clinically non-functioning pituitary macroadenomas: markers of tumour quiescence and regrowth. Clin Endocrinol (Oxf) 2003; 58: 763–9.
Wichers-Rother M, Hoven S, Kristof RA, Bliesener N, StoffelWagner B. Non-functioning pituitary adenomas: endocrinological and clinical outcome after trans-sphenoidal and transcranial surgery. Exp Clin Endocrinol Diabetes 2004; 112: 323–7.
Mortini P, Losa M, Barzaghi R, Boari N, Giovanelli M. Results of trans-sphenoidal surgery in a large series of patients with pituitary adenoma. Neurosurgery 2005; 56: 1222–33.
Turner HE, Stratton IM, Byrnet JV, Adams CBT, Wass JAH. Audit of selected patients with nonfunctioning pituitary adenomas treated without irradiation — a follow-up study. Clin Endocrinol 1999; 51: 281–4.
Boelaert K, Gittoes NL. Radiotherapy for non-functioning pituitary adenomas. Eur J Endocrinol 2001; 144: 569–75.
Woollons AC, Hunn MK, Rajapakse YR, et al. Non-functioning pituitary adenomas: indications for postoperative radiotherapy. Clin Endocrinol (Oxf) 2000; 53: 713–7.
Kokubo M, Sasai K, Shibamoto Y, et al. Long-term results of radiation therapy for pituitary adenoma. J Neurooncol 2000; 47: 79–84.
Park P, Chandler WF, Barkan AL, et al. The role of radiation therapy after surgical resection of non-functional pituitary macroade-nomas. Neurosurgery 2004; 55: 100–6.
Alameda C, Lucas T, Pineda E, et al. Experience in management of 51 non-functioning pituitary adenomas: indication for post-operative radiotherapy. J Endocrinol Invest 2005; 28: 18–22.
Fraioli B, Pastore FS, Signorotti S, De Caro GM, Giuffre R. The surgical treatment of pituitary adenomas in the eighth decade. Surg Neurol 1999; 261–6.
Kurosaki M, Ludecke DK, Flitsch J, Saeger W. Surgical treatment of clinically non-secreting pituitary adenomas in elderly patients. Neurosurgery 2000; 47: 843–8.
Minniti G, Esposito V, Piccirilli M, Fratticci A, Santoro A, Jaffrain-Rea ML. Diagnosis and management of pituitary tumors in the elderly: a review based on personal experience and evidence of literature. Eur J Endocrinol 2005; 153: 723–35.
Molitch ME. Evaluation and treatment of a patient with a pituitary incidentaloma. J Clin Endocrinol Metab 1999; 84: 3859–65.
Feldkamp J, Santen R, Harms E, Aulich A, Modder U, Scherbaum WA. Incidentally discovered pituitary lesions. High frequency of macroadenomas and hormone-secreting adenomas: results of a prospective study. Clin Endocrinol 1999; 51: 109–13.
Day PF, Guitelman M, Artese R, et al. Retrospective multicentric study of pituitary incidentalomas. Pituitary 2004; 7: 145–8.
Hartman ML, Crowe BJ, Biller BM, Ho KK, Clemmons DR, Chipman JJ, HypoCCS Advisory Board, U.S. HypoCCS Study Group. Which patients do not require a GH stimulation test for the diagnosis of adult GH deficiency? J Clin Endocrinol Metab 2002; 87: 477–85.
Baldelli R, Bianchi A, Diacono F, et al. Characteristics of adult patients with growth hormone deficiency who under-went neurosurgery for functioning and non-functioning pituitary adenomas and craniopharyngiomas. J Endocrinol Invest 2005; 28: 157–61.
Diederich S, Franzen NF, Bahr V, Oelkers. Severe hypona-tremia due to hypopituitarism with adrenal insufficiency: report of 28 cases. Eur J Endocrinol 2003; 148: 609–17.
Chanson P. Severe hyponatriemia as a frequent revealing sign of hypopituitarism after 60 years of age. Eur J Endocrinol 2003; 149: 177–8.
Olchovski D, Ezra D, Vered I, Hadani M, Shimon I. Symptomatic hyponatriemia as presenting sign of hypothalamic-pituitary disease: a syndrome of inappropriate secretion of antidiuretic hormone (SIADH)-like glucocorticosteroid responsive condition. J Endocrinol Invest 2005; 28: 151–6.
Nomikos P, Ladar C, Fahlbusch R, Buchfelder M. Impact of primary surgery on pituitary function in patients with non-functioning pituitary adenomas — a study of 721 patients. Acta Neurochir (Wien) 2004; 146: 27–35.
Kurosaki M, Sarger W, Ludecke DK Pituitary tumors in the elderly. Pathol Res Pract 2001; 197: 493–7.
Mastronardi L, Guiducci A, Puzzilli F, Maira G. Anterior pituitary adenomas in patients aged more than 65 years: analysis of growth fraction (using the MIB-1 monoclonal antibody) and of clinical features in comparison to younger patients. Clin Neurol Neurosurg 2002; 104: 44–8.
Tanaka Y, Hongo K, Tada T, Sakai K, Kakizawa Y, Kobayashi S. Growth pattern and rate in residual nonfunctioning pituitary adenomas: correlations among tumor volume doubling time, patient age, and MIB-1 index. J. Neurosurg 2003; 98: 359–65.
Warnet A, Harris AG, Renard E, Martin D, James-Deidier A, Chaumet-Riffaud P. A prospective multicenter trial of octreotide in 24 patients with visual defects caused by nonfunctioning and gonadotropin-secreting pituitary adenomas. French Multicenter Octreotide Study Group. Neurosurgery 1997; 41: 786–95.
Heaney AP, Fernando M, Melmed S. PPAR-gamma receptor ligands: novel therapy for pituitary adenomas. J Clin Invest 2003; 111: 1381–8.
Noad R, Narayanan KR, Howlett T, Lincoln NB, Page RC. Evaluation of the effect of radiotherapy for pituitary tumours on cognitive function and quality of life. Clin Oncol 2004; 16: 233–7.
Brada M, Ashley S, Ford D, Traish D, Burchell L, Rajan B. Cerebrovascular mortality in patients with pituitary adenoma. Clin Endocrinol 2002; 57: 713–7.
Gittoes NJ. Pituitary radiotherapy: current controversies. Trends Endocrinol Metab 2005; 16: 407–13.
Petrovich Z, Yu C, Giannotta SL, Zee CS, Apuzzo ML. Gamma knife radiosurgery for pituitary adenoma: early results. Neurosurgery 2003; 53: 51–9.
Losa M, Valle M, Mortini P, et al. Gamma knife surgery for treatment of residual non-functioning pituitary adenomas after surgical debulking. J Neurosurg 2004; 100: 438–44.
Picozzi P, Losa M, Mortini P, et al. Radiosurgery and the prevention of regrowth of incompletely removed non-functioning pituitary adenomas. J Neurosurg 2005; 102(Suppl): 71–4.
Sheehan JP, Niranjan A, Sheehan JM, et al. Stereotactic radio-surgery for pituitary adenomas: an intermediate review of its safety, efficacy, and role in the neurosurgical treatment armamentarium. J Neurosurgery 2005; 102: 678–91.
Muacevic A, Uhl E, Wowra B Gamma knife radiosurgery for non-functioning pituitary adenomas. Acta Neurochir Suppl 2004; 91: 51–4
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Del Monte, P., Foppiani, L., Ruelle, A. et al. Clinically non-functioning pituitary macroadenomas in the elderly. Aging Clin Exp Res 19, 34–40 (2007). https://doi.org/10.1007/BF03325208
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DOI: https://doi.org/10.1007/BF03325208