PITUITARY-TUMORS PRESENTING IN THE ELDERLY - MANAGEMENT AND OUTCOME

OBJECTIVE In elderly patients there are few data on the efficacy and s afety of pituitary surgery and radiotherapy (DXT). The aim of the pres ent study was to assess the mode of presentation, treatment and out co me of patients >64 years with a pituitary tumour presenting to a regio nal neuroendocrine service. DESIGN A retrospective case note review of all patients with a pituitary tumour, from 1986 to 1993, was performe d with DXT information from computerized records, PATIENTS Forty-four patients were identified: median age 70 (65-83) years; 25 males; follo wed for a mean of 34 (range 0-84) months, RESULTS The commonest presen ting symptom was with visual disturbance (24 patients) with a further 9 with asymptomatic visual field defects. Five patients had acromegaly and two prolactinoma, Thirty-two patients underwent transsphenoidal s urgery (TSS) (with post-operative DXT in 14 cases) and 6 craniotomy. T wo patients had DXT as the primary procedure and four were observed. V isual fields improved in 21 of 29 patients, Perioperative complication s occurred significantly more often after craniotomy (5/6) than after TSS (6/32) (P < 0.01). Eight patients died during the follow-up period (three deaths tumour related; one death followed DXT). CONCLUSIONS Pi tuitary adenoma is a remediable cause of visual disturbance in the eld erly, Most tumours were non-functioning. Age alone is not a contraindi cation to active treatment particularly with transsphenoidal surgery a nd radiotherapy.