Background. Craniopharyngioma (CP) is a rare tumor in the elderly whose clinical features and prognosis are not well known in this population. Aim. To evaluate the clinicopathological features and therapeutic outcomes of CP diagnosed in the elderly. Patients and Methods. A retrospective, multicenter, national study of CP patients diagnosed over the age of 65 years and surgically treated was performed. Results. From a total of 384 adult CP patients, we selected 53 (13.8%) patients [27 women (50.9%), mean age 72.3 ± 5.1 years (range 65-83 yr)] diagnosed after the age of 65 years. The most common clinical symptoms were visual field defects (71.2%) followed by headache (45.3%). Maximum tumor diameter was 2.9 ± 1.1 cm. In most patients, the tumor was suprasellar (96.2%) and mixed (solid-cystic) (58.5%). The surgical approach most commonly used was transcranial surgery (52.8%) and more than half of the patients (54.7%) underwent subtotal resection (STR). Adamantinomatous CP (ACP) and papillary CP (PCP) were present in 51% and 45.1%, respectively, with mixed forms in the remaining. Surgery was accompanied by an improvement in visual field defects and in headaches; however, pituitary hormonal hypofunction increased, mainly at the expense of an increase in the prevalence of diabetes insipidus (DI) (from 3.9% to 69.2%). Near-total resection (NTR) was associated with a higher prevalence of DI compared with subtotal resection (87.5 vs 53.6%, p=0.008). Patients were followed for 46.7±40.8 months. Mortality rate was 39.6% with a median survival time of 88 (95% CI, 57-118) months. DI at last visit was associated with a lower survival. Conclusion. CP diagnosed in the elderly shows a similar distribution by sex and histologic forms than that diagnosed at younger ages. At presentation visual field alterations and headaches are the main clinical symptoms which improve substantially with surgery. However, surgery, mainly NTR, is accompanied by worsening of pituitary function, especially DI, which seems to be a predictor of mortality in this population.

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The localization of primary hyperaldosteronism is often difficult. The coexistence of nonfunctioning adenomas is common in patients older 40 years old and small adenomas undetectable by CT could confuse with bilateral hyperplasia. The AVS is considered the "gold standard" test for the location of numerous guides. We describe our experience in a clinical case of primary aldosteronism .We present a 58 years old woman with refractory hypertension with quadruple therapy. Biochemical analysis showed a hypokalemic alkalosis and a hyporeninemic aldosteronism (aldosterone/plasma renin activity: 130). We discard renal artery stenosis by doppler ultrasound. CT shown a 16 mm nodule with low density and homogeneous in right adrenal, and other 23 mm nodule with high density and heterogeneous in the left adrenal .The patient was diagnosed of primary aldosteronism. We tried to locate the adrenal responsible with AVS by the following protocol. We suspended antihypertensive drugs with interference in angiotensin/ aldosterone axis . We administered 250 ug of ACTH iv 15 minutes before to stimulation . By sequential catheterization right femoral vein access we had baseline samples , at 30 ' and 45' in left adrenal vein (LAV), right adrenal vein (RAV), and inferior cava vein (ICV)We considered a conscious aldosterone/cortisol (A/C) > 4 between both adrenal veins as confirmation of lateralization .During the performance at 30 minutes was impossible to catheterize the right adrenal vein for collapse, so we end the test at this time. However we get a baseline ratio A/C adrenal left: A/C right adrenal (basal) of 18.47 (> 4) which confirms a left lateralization. No major complications, except controlled pain in inguinal region were observed. Finally the patient was operated by left adrenalectomy and the arterial pressure values were normalized without any treatment.The AVS is considered the "gold standard" test for localization of adrenal adenomas. However is a invasive test, complex ,with complications, and requires a trained team. Furthermore there isn´t consensus in the test protocol and their interpretation . All this hinders their realization, however help to identify lateralization hyperaldosteronism, avoiding misdiagnosis, as in this case.

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