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International Journal of Clinical Case Reports 2014, Vol. 4, No. 5, 1-3
http://ijccr.biopublisher.ca
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Figure 2 Giant adenoma invading cavernous sinuses
3 Results
Among 37 adenomas, 38 % (N=14, 9F/5M) were
giants and/or invasive. Adenoma size was 40.53 ±
11.38 mm in G1 and 22.7 ± 7.96 mm in G2.
Cavernous sinuses were involved in 16 %. Patients of
G1 were older than those of G2: 70.71 ± 6.70 years vs
66.17 ± 5.41 years. Neuro-ophtalmological complaints
were the most frequent appealing symptoms, present
in 78% in G1 and 61% in G2, appealing symptoms are
described in Table 1. The adenomas were most often
non functioning in both groups: 64% in G1 and 61%
in G2, the nature of pituitary adenoma is reported in
Table 2. Hormonal assessment revealed pituitary
deficiency in 61% in G1 and 60% in G2 whereas
visual evaluation found visual impairment in 71% in
G1 and 33% in G2.
Table 1 Appealing symptoms
Appealing symptoms
G1
G2
Neuro-ophtlmological symptoms
78%
61%
Endocrinological symptoms (acromegalic features, decreased libido, signs of
pituitary deficiency)
15%
18%
Incidental discovery
7%
21%
Table 2 Nature of pituitary adenoma
Nature of pituitary adenoma
G1
G2
Non functioning adenoma
64% 61%
GH secreting adenoma
0% 22%
Prolactinoma
22% 13%
Gonadotroph adenoma
14% 4%
4 Discussion
Pituitary adenomas in the elderly are deemed to be
rare representing less than 10% of all PA (Barzaghi et
al., 2007), although autopsies studies didn’t find
differences in the prevalence of PA between old and
young patients suggesting that many adenomas are
undiagnosed in old subjects (Burrows et al., 1981).
However, incidence of PA is increasing due to the
increase in life expectancy in one side, on the other
side and because old people are prone to
neurovascular and neurocognitive diseases, more
neuroimaging procedures are performed so many
pituitary tumours are incidentally discovered. In our
study, in contrast to autopsy series where micro
adenomas and prolactinomas are predominating, we
found a preponderance of macro adenomas and non
functioning adenomas as reported by other authors
(Burrows et al., 1997; Cohen et al., 1989; Hong et al.,
2008), Hong and al in their report of 103 adenomas,
all were macro adenomas and 75% were non
functioning (Hong et al., 2008). 38% of our adenomas
were aggressive tumours either giants ones or
adenomas invading cavernous sinuses, age related
changes and associated diseases may explain the delay
in diagnosis and the invasiveness of PA as visual
abnormalities and clinical
manifestations of
hypopituitarism are often attributed to ageing. In our
study GH secreting adenomas were smaller and less
invasive than other types, they were diagnosed only in
G2, an age related decrease in cell proliferation rate
has been observed in GH secreting adenomas in old
patients (Jaffrain-Rea et al., 2002). Conversely,
prolactinomas as we observed present clinically as
non secreting and are usually invasive (Minniti et al.,
2005).
Pituitary tumours are increasingly recognized on
cerebral imaging performed for other complaints
(Turner et al., 1999) especially in the less invasive
tumours as we observed, PA were incidentally
discovered only in G2, though these incidentalomas
are not really asymptomatic as some of these patients
have longstanding symptoms compatible with
pituitary tumours that have been misattributed to