Pituitary adenomas in older patients - approaches, challenges and future directions

Several pituitary adenomas are diagnosed at an old age. Over the decades, the increase in life expectancy has led to fundamental changes in the age structure of the society. As a result of this, the number of elderly patients newly diagnosed or living with a pituitary adenoma is increasing. Clinical phenotypes in this group often differ from that encountered in younger patients, and ageing can have a negative impact on pituitary adenoma-related comorbidities. Timely diagnosis may be influenced by factors including confusion with physical changes occurring during normal ageing, presence of visual abnormalities mimicking those caused by pituitary adenomas and age-related alterations in pituitary function. In this review, we present data on various types of pituitary adenomas diagnosed in the elderly from the published literature of the last 20 years, discuss differences with younger patients and highlight diagnostic and therapeutic challenges in this field. Overall, essential priority is to offer a patient-tailored management strategy which will be effective, safe, pragmatic, enhancing optimal age-adjusted quality of life and considering patient wishes and frailty. Directing the management to centers of excellence with proven and established surgical/endocrine expertise combined with wider multi-disciplinary input will serve this priority.