The Presentation and Management of Pituitary Tumours in the Elderly

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Abstract
Twenty-two patients presenting with pituitary tumours (16 non-functioning) after the age of 70 years were identified in a review of all patients assessed in Oxford hospitals between 1982 and 1986. They were matched with younger patients, to compare modes of presentation and treatment outcome. Younger patients presented more commonly than elderly with symptoms of deficiency of adrenocorticotrophic hormone, thyroid-stimulating hormone or gonadotrophin, although the prevalence of biochemical deficiency was similar in the two groups. Trans-sphenoidal adenomectomy was performed on 12 elderly patients with visual impairment. Of those with field loss, seven improved, one was unchanged and two deteriorated after surgery, though one of the last was improved by haematoma evacuation, and two cranial nerve palsies resolved. There were no other pen-operative complications in the elderly. Transsphenoidal surgery is the treatment of choice for non-functioning turnouts causing visual failure; it decompresses the adenoma with minimal morbidity and endocrine impairment, and is well tolerated by elderly patients.