Introduction: Pituitary adenomas are the most common intracranial neoplasm, and are most frequently
benign. They vary greatly in their composition, as they can be functional and secrete
hormones or they can be non-functional. Furthermore, any kind of tumor can cause symptoms
of mass effect if large enough. One such symptom is visual impairment due to compression
of the optic chiasm. Rates of visual impairment vary, and it is important to elucidate
factors correlated with visual impairment. In addition, age at diagnosis for pituitary
tumors vary greatly along with their presentation. Examining the relationship between
age at diagnosis and visual impairment can allow us to characterize why certain patients
do and do not present with vision loss.
Objective: In this single-center study, we aimed to determine if age at presentation was associated
with rates of vision loss, and if this effect could be explained by tumor volume and
cavernous sinus invasion.
Methods: We conducted a retrospective chart review of patients treated for pituitary adenoma
between 2017 and 2023 at single academic tertiary care center. A total of 123 patients
were included in this study. By race, 64 (52%) patients were Black, 14 (11%) patients
were White, 2 (2%) were Asian, and 43 (35%) were other or declined to respond. By
ethnicity, 39 (32%) patients were Hispanic/Latino, 71 (58%) were non-Hispanic/Latino,
and 13 (11%) declined to respond. Vision loss was determined to be any presence of
vision loss within one year prior to tumor resection. Tumor volume was calculated
using the traditional formula: (AP × CC × TR)/2, where AP, CC, and TR refer to the
three dimensions of the tumor in centimeters. Cavernous sinus invasion was determined
by preoperative radiology reports.
Results: In our patient population, the average age at presentation was 54.8 years. Our analysis
showed that those with vision loss at presentation, were, on average, older than those
who did not have vision loss at presentation (57.2 ± 13.7 years [n = 82] vs. 49.9 ± 16.8 years [n = 41]; p = 0.02*). However, using simple linear regression, there was no correlation between
age and tumor volume (r
2 = 0.02; p = 0.18). Furthermore, there was no difference in age between those who had cavernous
sinus invasion and those who did not (55.4 ± 17.8 years [n = 57] vs 52.3 ± 13.8 years [n = 42]; p = 0.32).
Conclusion: In our study, we found that those with pituitary tumors who presented with vision
loss were older than those who did not. Prior studies show that vision loss can be
associated with increased tumor volume. However, in our population, older patients
who had increased rates of vision loss did not have increased tumor volume nor increased
likelihood of cavernous sinus invasion. Further studies are needed to ascertain why
older patients seemingly have higher rates of vision loss from pituitary tumors independent
of their tumor volume, possibly related to age-related thinning of and increased vulnerability
of the optic apparatus.
