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

Clinical article

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Object

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.

Methods

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

Results

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).

Conclusions

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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Figures

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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).

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    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).

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    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).

References

  • 1

    Barker FG IIKlibanski ASwearingen B: Transsphenoidal surgery for pituitary tumors in the United States, 1996–2000: mortality, morbidity, and the effects of hospital and surgeon volume. J Clin Endocrinol Metab 88:470947192003

  • 2

    Bosl GJVogelzang NJGoldman AFraley EELange PHLevitt SH: Impact of delay in diagnosis on clinical stage of testicular cancer. Lancet 2:9709731981

  • 3

    Botteri EBagnardi VGoldhirsch AViale GRotmensz N: Axillary lymph node involvement in women with breast cancer: does it depend on age?. Clin Breast Cancer 10:3183212010

  • 4

    Cohen ARCooper PRKupersmith MJFlamm ESRansohoff J: Visual recovery after transsphenoidal removal of pituitary adenomas. Neurosurgery 17:4464521985

  • 5

    Ebersold MJQuast LMLaws ER JrScheithauer BRandall RV: Long-term results in transsphenoidal removal of nonfunctioning pituitary adenomas. J Neurosurg 64:7137191986

  • 6

    Ezzat SAsa SLCouldwell WTBarr CEDodge WEVance ML: The prevalence of pituitary adenomas: a systematic review. Cancer 101:6136192004

  • 7

    Fraser SBunce CWormald R: Retrospective analysis of risk factors for late presentation of chronic glaucoma. Br J Ophthalmol 83:24281999

  • 8

    Gjørup THendriksen CLund EStrømgård E: Is growing old a disease? A study of the attitudes of elderly people to physical symptoms. J Chronic Dis 40:109510981987

  • 9

    Gnanalingham KKBhattacharjee SPennington RNg JMendoza N: The time course of visual field recovery following transphenoidal surgery for pituitary adenomas: predictive factors for a good outcome. J Neurol Neurosurg Psychiatry 76:4154192005

  • 10

    Goldberg RJGurwitz JHGore JM: Duration of, and temporal trends (1994–1997) in, prehospital delay in patients with acute myocardial infarction: the second National Registry of Myocardial Infarction. Arch Intern Med 159:214121471999

  • 11

    Gurwitz JHMcLaughlin TJWillison DJGuadagnoli EHauptman PJGao X: Delayed hospital presentation in patients who have had acute myocardial infarction. Ann Intern Med 126:5935991997

  • 12

    Keller MLLeventhal HProhaska TRLeventhal EA: Beliefs about aging and illness in a community sample. Res Nurs Health 12:2472551989

  • 13

    Kothari AFentiman IS: 22. Diagnostic delays in breast cancer and impact on survival. Int J Clin Pract 57:2002032003

  • 14

    Kurosaki MLüdecke DKFlitsch JSaeger W: Surgical treatment of clinically nonsecreting pituitary adenomas in elderly patients. Neurosurgery 47:8438492000

  • 15

    Muir KWSantiago-Turla CStinnett SSHerndon LWAllingham RRChalla P: Health literacy and vision-related quality of life. Br J Ophthalmol 92:7797822008

  • 16

    Quillen DA: Common causes of vision loss in elderly patients. Am Fam Physician 60:991081999

  • 17

    Robinson EMohilever JZidan JSapir D: Delay in diagnosis of cancer. Possible effects on the stage of disease and survival. Cancer 54:145414601984

  • 18

    Snyder PJ: Clinically nonfunctioning pituitary adenomas. Endocrinol Metab Clin North Am 22:1631751993

  • 19

    Surawicz TSMcCarthy BJKupelian VJukich PJBruner JMDavis FG: Descriptive epidemiology of primary brain and CNS tumors: results from the Central Brain Tumor Registry of the United States, 1990–1994. Neuro Oncol 1:14251999

  • 20

    Wormald R: Delivery of eye care to the elderly: practical considerations. Community Eye Health 12:671999

  • 21

    Zapka JGOakes JMSimons-Morton DGMann NCGoldberg RSellers DE: Missed opportunities to impact fast response to AMI symptoms. Patient Educ Couns 40:67822000

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