Patients with pituitary macroadenomas: what do they complain about and whom do they visit first?
Authors: Krivosheeva Yulia G. , Ilovayskaya Irena A. , Dreval Alexander V. , Stashuk Galina A. 
Published: October 2016

Aim: to evaluate the primary complaints of patients with pituitary macroadenomas and “first-referred” specialists for them.Material and Methods. 351 with pituitary macroadenomas (at least one size >10 mm) were examined: 144 non-functional adenomas (NFA), 65 macroprolactinomas, 142 somatotropinomas. A pituitary adenoma was considered as giant if at least one of the sizes was >40 mm. MRI with an impact study of the pituitary was performed on high field instrument Intera Achieva (PHILIPS company) 3.0 TL, with intravenous extracellular gadolinium contrast agents. Statistical analysis of the results was carried out using the IBM statistical program SPSS Statistics 20 for Windows 7.0 with variation statistics methods for nonparametric data. The data are expressed as Mе [25%, 75%].Results. The patients’ age ranged from 20 to 80 years and were: NFA 60 [51; 66] y.o., prolactinomas 44 [35; 59] y.o. and somatotropinomas 57 [47; 66] y.o. (р<0.001). Pituitary tumour volumes were: NFA 5,526 [2,460; 11,774] mm3, prolactinomas 5,275 [1,408; 10,566]) mm3 and somatotropinomas 2,814 [1,226; 4,708] mm3 (р<0.001). First patients’ complaints were: NFA – headache (61.7%) and visual disorders (34.8%), prolactinomas – headache (36.8%) and menstrual disorders (27.3%), somatotropinomas – appearance change (31.1%) and headache (32.8%). There was no correlation found between headache and tumour volume however significant correlation was revealed between visual disorders and tumour volume as well as vertical and sagittal sizes of the tumour. The most often “first referred” specialists were: NFA – neurologist (43%) and ophthalmologist (20%), prolactinomas – gynecologist (36.4% of patients of reproductive age) and neurologist (31%); somatotropinomas – endocrinologist (28%) and therapist (25%). Among macroadenomas 32 giant tumors were found: 18 NFA (12.5% of all NFA group), 8 (12.3%) prolactinomas, 6 (4.2%) somatotropinomas. The median age of patients with giant macroadenomas were: NFA 54 [38; 68] y.o., prolactinomas 29 [25; 43] y.o. and somatotropinomas 34 [24; 46] y.o. Tumour volumes of giant adenomas were: NFA 28,190 [21,143; 44,896] mm3; prolactinomas 38,592 [15,994; 78,606] мм3; and somatotropinomas 51,209 [36,703; 102,207] mm3 (p<0.001). Main complaints for patient with giant pituitary tumours were visual impairment (60%, 18 patients – 11 patients with NFA, 4 prolactinomas and 3 somatotropinomas) and headache (44%, 14 patients – 8 patients with NFA, 5 prolactinomas and 1 patient with somatotropinoma). The most often “first referred” specialists were ophthalmologist (50%, 16 patients – 9 patients with NFA, 4 prolactinomas and 3 somatotropinomas) and neurologist (34.4%, 11 cases – 8 patients with NFA, 2 with prolactinomas and 1 with somatotropinoma). Conclusions. Headache and visual impairment were the most often complaints in our cohort of macroadenoma patients, however there were some discrepancies between groups of tumours with different hormonal activity. Neurologist and ophthalmologist should be aware of patients with pituitary macroadenomas, headache and visual disorders should be strong indications for pituitary MRI especially in patients younger than 50.