Clinical Presentations of Pituitary Adenomas at a University Hospital in Jamaica

摘要

Pituitary tumors account for approximately 10-15% of primary brain tumours worldwide. It is important for clinicians be familiar with the varied modes of presentation since favorable therapeutic outcomes depend on an early diagnosis. We sought to document the clinical presentation in patients with pituitary tumours. Methods:We performed a retrospective analysis of hospital records from all patients with pituitary tumours treated over 15 years from January 1989 to June 2005. The information collected included patient demographics, duration of symptoms, presenting clinical features, visual field testing and hormone assays. Data were analyzed using SPSS version 12.0. Results:Pituitary tumours were present in 119 patients, with a 1:1.6 male to female ratio. There were 73 females and 46 males, who presented at a mean age of 45.4 years (SD +/-14.8; Range 10-79; Median 45; Mode 45).Non-functional tumours were present in 55% of patients at a mean age of 50.8 years (SD +/-13.4; Median 51; Mode 63) while patients with hormonally active tumours presented earlier at a mean age of 39.2 years (SD +/-13.9; Median 38; Mode 45).Visual disturbances were present in 80.7% of patients with hormonally inactive tumours, and included field deficits (79.1%) and abnormal acuity (92.5%). The other non-hormonal presentations included non-specific headaches (72.3%), cranial nerve palsies (16%) and pituitary apoplexy (5%).The commoner endocrine presentations included hyper-prolactinemia (24.4%), amenorrhoea (21.9%), hypothyroidism (7.6%), acromegaly (5.9%), cushing’s disease (4.2%) and hyperthyroidism (0.8%). Conclusion:Most patients present relatively late because the majority of pituitary tumours are hormonally inactive. Visual disturbances, headaches and symptoms of hyper-prolactinemia are common presenting complaints. Heightened clinical vigilance and early investigation in patients with suggestive clinical presentations may improve the results of treatment of this common disorder. Introduction Pituitary tumors are relatively common neoplasms, accounting for approximately 10-15% of all primary brain tumours [123] . The prevalence of pituitary tumours at the University Hospital of the West Indies (UHWI) in Jamaica is comparable to international reports [34567] . Autopsy studies at the UHWI have revealed that asymptomatic pituitary adenomas occur in 10% of unselected subjects [4] . It is important for clinicians be familiar with the varied modes of clinical presentation since favorable therapeutic outcomes depend on an early diagnosis. In order to increase clinician awareness, we sought to document the presenting clinical features in patients diagnosed with pituitary tumours over 15 years in this setting. Methods The UHWI is a 500-bed tertiary referral center in Kingston, Jamaica with seven operating theatre suites and two eight-bed multidisciplinary Intensive Care Units. This centre serves as a referral centre for patients diagnosed with intra-cranial tumours who require neurosurgical intervention.We retrospectively examined admission records from the UHWI over a period of 15 years from January 1989 to June 2005. Hospital records of all patients treated for pituitary tumours were retrieved, the relevant data extracted and entered in a Microsoft Excel ? worksheet. The information collected included patient demographics, duration of symptoms, presenting clinical features, visual field testing and hormone assays. Visual field examinations were performed using perimetry and visual analyzers. Data were analyzed using SPSS version 12. Results Over the study period there were 119 patients treated at the UHWI with pituitary tumours. There was a 1:1.6 male to female ratio, with 73 (61.3%) females and 46 (38.7%) males. These patients presented at a mean age of 45.4 years (SD +/-14.8; Range 10-79; Median 45; Mode 45). At the time of diagnosis, 31 (30.4%) patients had co-morbid illnesses, most commonly hypertension (34.3%) and diabetes mellitus (9.8%). The most com