2025 Proffered Presentations
S030: UNDERSTANDING THE DISTRIBUTION OF PITUITARY ADENOMAS MANAGED BY NEUROSURGERY IN A SOCIALLY VULNERABLE POPULATION
Anne R Lally, BA; Sayak R Ghosh, BS; Isabella L Pecorari, BS; Vijay Agarwal, MD; Albert Einstein College of Medicine
Introduction: Pituitary adenomas are classified according to their size and cell-type of origin. While a third to half of pituitary adenomas do not secrete hormones (NFA), a majority of pituitary adenomas are functional. Secreted hormones include prolactin, growth hormone, adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), and gonadotropin-secreting hormones. However, not all adenomas that stain for hormone-secreting cells are truly functional. Microsurgical removal is the standard of care for all types of clinically significant pituitary adenomas, except prolactinomas. Studies about the distribution of pituitary adenomas on which neurological surgeons operate have occurred mainly in European-predominate, wealthier patient populations. In these studies, resections of NFA are most common, accounting for 30% of cases, while tumors secreting growth hormone are the second most common, accounting for slightly under 30% of cases. The aim of this study is to better understand the distribution of pituitary adenomas which are managed by neurosurgeons in an ethnically diverse patient population that has high social vulnerability.
Methods: A retrospective review was completed for patients with suspected pituitary adenomas who underwent surgical resection and histological confirmation between 2018 and 2022 at a single institution. A chart review of each patient’s medical record was done to obtain demographic information, tumor size, histology of the tumor, and the functionality of the tumor. Variables related to the patients’ socioeconomic status were also recorded using social vulnerability index (SVI) scores from the Centers for Disease Control Agency for Toxic Substances and Disease Registry. Proportions were used to examine the frequency of histological and functional types; means and standard deviation were calculated to evaluate continuous variables.
Results: A total of 153 patients were included in this analysis. Of these patients, there were 77 (50.33%) male and 76 (49.67%) female The average age was 54.72 ± 15.63 years. Seventy-nine patients (52%) identified as Black, 14 (9%) as White, 2 (1%) as Asian, 48 (31%) as Other, and 11 (7%) with no race recorded. The mean overall SVI score is 0.811 ± 0.229, with 138 (90%) patients having a score indicating high social vulnerability. On histology, there were 60 (39%) gonadotrophs, 23 (15%) hormone-negative, 16 (10%) lactotrophs, 16 (10%) corticotrophs, 13 (8%) null cell, 9 (6%) necrotic, 7 (5%) somatotrophs, and 9 (6%) of tumors presented with multiple cell-types. Among these patients, 123 (80%) presented with symptoms from a NFA, 18 (12%) presented with symptoms of hyperprolactinemia, 6 (4%) presented with acromegaly, 4 (3%) presented with Cushing disease, 2 (1%) presented with symptoms from elevated gonadotropins.
Conclusions: In this study of patients with high SVI scores, there is a higher percentage of patients presenting without symptoms of hormonal imbalance and a lower percentage of patients presenting with acromegaly. Barriers to care may prevent patients with subtle, slowly progressing symptoms from presenting to care. In addition, socially vulnerable patients may be more likely to be managed medically for acromegaly. More research needs to be conducted to understand the relationship between socioeconomic vulnerability and management of pituitary adenomas.