Factors associated with delay to pituitary adenoma diagnosis in patients with visual loss

Clinical article

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The duration of visual symptoms associated with a nonfunctioning pituitary adenoma (NFA) is a predictive factor for chances of visual improvement. The authors investigated factors associated with increased duration of visual symptoms in patients with NFAs.


The authors retrospectively reviewed NFAs resected at their institution between 2004 and 2010 for duration of visual symptoms, postoperative improvement, and associated factors.


Seventy-five patients underwent NFA resection with a median visual symptom duration of 6.5 months (range 1 week–15 years). A multivariate logistic regression showed that duration of symptoms (p = 0.04), but not age at surgery (p = 0.2), predicted postoperative normalization of vision. Univariate nonparametric analyses investigating age at symptom onset, sex, race, insurance type, ophthalmological conditions, income, marital status, emergency department admission, language, and medical provider found that age was the only variable significantly prolonging symptom duration (p = 0.04), a finding confirmed by a multivariate regression analysis. Patients 20–39, 40–59, and 60–79 years old had median durations of symptoms of 4, 7, and 9 months, respectively. Seven older patients had symptoms attributed to preexisting ophthalmological conditions for a median of 18 months before NFA diagnosis. Among age and race subgroups, the largest difference in median symptom duration was between white patients in the 60–79-year age range (duration of 5 months) and nonwhite patients in the 60–79-year age range (duration of 24 months) (p = 0.04).


The authors found that older age was associated with delayed NFA diagnosis in visually impaired patients. Contributing factors were the attributing of visual symptoms from NFAs to other ophthalmological conditions in these patients, and delayed presentation in elderly nonwhite patients. These findings highlight challenges associated with timely NFA diagnosis in visually impaired patients, a key factor for chances of improvement.

Abbreviation used in this paper: NFA = nonfunctioning pituitary adenoma.

Article Information

Address correspondence to: Manish K. Aghi, M.D., Ph.D., Department of Neurological Surgery, University of California at San Francisco (UCSF), The California Center for Pituitary Disorders, 505 Parnassus Avenue Room M779, San Francisco, California 94143-0112. email: AghiM@neurosurg.ucsf.edu.

Please include this information when citing this paper: published online July 8, 2011; DOI: 10.3171/2011.6.JNS101663.

© AANS, except where prohibited by US copyright law.



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    Difference in duration of symptoms in patients with or without postoperative normalization of vision. Box and whisker plot illustrating the minimum (lower whisker), 25th percentile (lower edge of box), median (line in the box), 75th percentile (upper edge of box), and maximum (upper whisker) duration of visual symptoms in months (on a logarithmic scale on the y axis) in patients without and with postoperative normalization of vision. Patients who had return to baseline vision had a shorter duration of symptoms than patients who did not have return to baseline vision (p = 0.048). n = number of patients.

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    Interaction of age and duration of visual symptoms with chances of return to baseline vision after surgery. Three-dimensional graph in which patients are stratified into 3 groups by age at the time of surgery on the x axis (Age 20s–30s, Age 40s–50s, and Age 60s–80s), 2 groups by duration of symptoms on the z axis (over 6 months vs 6 or fewer months), and percentage of patients with postoperative return to baseline vision on the y axis. While the difference in return to baseline vision between those with visual symptoms for 6 months or fewer (violet) versus those with visual symptoms for over 6 months (fuchsia) was negligible when patients were in their 20s and 30s (p = 0.5), the difference became significant when patients were in their 40s and 50s (p = 0.046) and when they were older than 60 years (p = 0.007).

  • View in gallery

    Duration of visual symptoms as a function of patient's age at symptom onset. Box and whisker plot illustrating the minimum (lower whisker), 25th percentile (lower edge of box), median (line in the box), 75th percentile (upper edge of box), and maximum (upper whisker) duration of visual symptoms in months (on a logarithmic scale on the y axis) in 3 age groups spanning 2 decades per age group (20–39 years, 40–59 years, and 60–79 years). There was a trend toward an increased duration of visual symptoms from the lower to the upper age group (p = 0.04).

  • View in gallery

    Duration of visual symptoms as a function of patient's age at the time of diagnosis and patient's race. Box and whisker plot illustrating the minimum (lower whisker), 25th percentile (lower edge of box), median (line in the box), 75th percentile (upper edge of box), and maximum (upper whisker) duration of visual symptoms in months (on a logarithmic scale on the y axis) among 6 groupings of patients by 2 decade age intervals (20–39 years, 40–59 years, and 60–79 years) and by nonwhite versus white race. Among the 3 age groups subdivided into nonwhite versus white patients, the difference in duration of visual symptoms between nonwhite and white patients only became significant among patients 60–79 years (p = 0.04).


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