PREDIAGNOSTIC NATURAL-HISTORY AND INITIAL SYMPTOMS IN 517 PATIENTS WITH HYPOPHYSEAL ADENOMA

Objective: To find out whether recent techniques of investigating hypo physeal adenoma (computed tomography, magnetic resonance imaging and h ormonal measurements) have brought about earlier diagnosis. Patients a nd methods: The time of onset of first symptoms and the duration from first symptoms to diagnosis (anamnestic time) were determined retrospe ctively from clinical, endocrinological, ophthalmological and localizi ng data on 517 patients (311 women, 206 men) with hypophyseal adenoma. Results: The most common initial symptom was oligo- or amenorrhoea, i n 57.9% of women, and disturbed libido or potency in 38.5% of men. Nex t most common were visual field deficits (women: 11.6%, men: 26.7%), s igns of acromegaly (women: 11.3%, men 18.2%) and headaches (women. 11. 3%, men 15.5%). The median anamnestic time in women, 3.0 years, was si gnificantly longer than the 2.3 years in men (P < 0.001). In hormonall y inactive adenoma the corresponding times were 2.0 years in women and 1.0 year in men; in prolactinoma 4.2 years and 2.0 years; in growth-h ormone secreting adenoma 5.0 years and 5.5; and in ACTH-secreting aden oma 5.0 years and 1.0 year. Conclusions:Although diagnostic techniques have greatly improved, the anamnestic time for hypophyseal adenoma is not shorter than in earlier studies. This findings underlines the nee d for clearly directed history-taking and for good training in endocri nology.