SAT-125 - Epidemiology of Pituitary Adenomas in an Academic Safety Net Medical Center

Background
Pituitary adenomas account for 5-20% of intracranial tumors, and their epidemiology, clinical presentation, and treatment outcomes have not been described in patients from racially, ethnically, and socioeconomically diverse backgrounds.
Objective
To characterize the epidemiology, treatment, and clinical outcomes of pituitary adenomas in a large, diverse safety-net population, and to establish a longitudinal cohort serving as a resource for studying the impact of socioeconomic and demographic factors on pituitary tumors.
Methods
We conducted a retrospective descriptive study of patients with pituitary tumors treated within the Los Angeles County Department of Health Services (DHS) safety-net system from November 2014 to November 2022. Patients were identified using ICD and CPT codes for pituitary adenomas and related disorders, with inclusion limited to those with more than one DHS encounter to ensure there is longitudinal follow-up. Of note, prolactinomas do not have a ICD code and we used hyperprolactinemia+pituitary tumor to identity them. Electronic medical records were reviewed to extract clinical, and treatment data.

Results:
Among 1,707 patients meeting inclusion criteria, pituitary adenoma subtypes included prolactinomas (n = 697), acromegaly (n = 93), pituitary-dependent Cushing disease (n = 30) and presumed nonfunctioning adenomas (n = 887). The cohort was predominantly female (n = 1,289) with 417 males. Age distributions differed by sex and tumor type, with median age 40–50 years for females and 30–40 years for males with acromegaly, and 45–60 years for both sexes in Cushing disease. Most patients were Hispanic/Latino (n = 1,233) and insured through Medi-Cal (n = 1,410).Within prolactinomas, PRL levels were < 100 ng/mL in 307 patients, 100–200 ng/mL in 121, and >200 ng/mL in 114; dopamine agonists were the primary treatment across all strata, with 7% (n=41) undergoing surgery. Among patients with acromegaly, 86% (n = 80) underwent surgery, 44% (n = 41) had residual disease, 45% (n = 42) required ongoing medical therapy, and 12% (n = 11) received radiation. In Cushing disease, 77% (n = 23) underwent surgery, 27% (n = 8) required repeat operations, and 47% (n = 14)had residual hypercortisolemia, with 43% (n = 13) treated medically and 10% (n = 3) receiving radiation. Of the remaining presumed nonfunctioning adenomas, 26% (n=230) underwent surgical resection, a subset that may have included misclassified gonadotrophin secreting tumors.

Conclusion:
Although patterns of treatment were comparable to those reported in other cohorts, this safety-net population demonstrated a later age at diagnosis and a marked female predominance. Key limitations include lack of ICD coding for prolactinomas and incomplete coding documentation. Despite these limitations, this cohort provides important insight into pituitary adenoma care in a diverse, underserved population.

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