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Impact of age on postsurgical outcomes of nonfunctioning pituitary adenomas

  • Endocrine Surgery
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Abstract

Purpose

The management of pituitary adenomas in the elderly has become a relevant clinical issue, in relationship with improved life expectancy and spreading use of imaging techniques. In this single-center and retrospective study, we investigated the impact of age on peri- and postsurgical outcomes in patients undergoing transnasal sphenoidal (TNS) surgery for pituitary adenomas.

Methods

One-hundred-sixty-nine patients (62% males) undergoing endoscopic transphenoidal (TNS) surgery for nonfunctioning pituitary adenomas (NFPAs) were enrolled. Patients were subdivided into three groups according to age tertiles: ≤56 (group 1), 57–69 (group 2), and ≥70 (group 3) years. Postsurgical and endocrinological outcomes were evaluated and compared among the three age groups.

Results

37/169 patients (21.9%) developed at least one perisurgical complication, without significant association with the patients’ age (P = 0.838), Charlson co-morbidity score (P = 0.326), and American Society of Anesthesiologist score (P = 0.616). In the multivariate regression analysis, the adenoma size resulted the only determinant of perisurgical complication (odds ratio [OR] 1.07, 95% confidence interval [C.I.] 1.00–1.13; P = 0.044). The development and the recovery of at least one pituitary hormone deficiency were observed in 12.2% and 14.2% of patients, respectively. The risk of developing new pituitary hormone deficiencies was correlated with cavernous sinus invasion as evaluated by magnetic resonance imaging (hazard ratio [HR] 4.19, 95% C.I. 1.39–12.66; P = 0.010), whereas the probability to normalize at least one pituitary hormone deficiency was significantly correlated with younger age of patients (HR 0.27, 95% CI 0.12–0.61; P = 0.002).

Conclusions

The results of this study reinforce the concept that endoscopic TNS surgery is a safe therapeutic option in the elderly patients with NFPA, even in presence of comorbidities and high anesthetic risk.

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Author notes

  1. These authors contributed equally: E. Biamonte, N. Betella

Authors and Affiliations

  1. Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy

    E. Biamonte, N. Betella, S. Ariano, E. Lavezzi, G. Mazziotti & A. Lania

  2. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy

    E. Biamonte, S. Ariano, G. Mazziotti & A. Lania

  3. Neurosurgery Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy

    D. Milani, G. B. Lasio & S. Radice

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Correspondence to G. Mazziotti.

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Biamonte, E., Betella, N., Milani, D. et al. Impact of age on postsurgical outcomes of nonfunctioning pituitary adenomas. Endocrine 72, 915–922 (2021). https://doi.org/10.1007/s12020-020-02554-4

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