Abstract
Purpose
Along with increased life expectancy and improvements in the diagnostic tools and techniques, the number of elderly patients with symptomatic pituitary tumors being evaluated for surgery is increasing. To date, contrasting results of the safety and effectiveness of transsphenoidal surgery in patients over 65 years old were published in the medical literature. An investigation concerning the extension of resection, post operative complications and, recovery rate from endocrinological and visual symptoms in elderly patients who underwent transsphenoidal surgery for pituitary adenoma was conducted.
Methods
A retrospective review, which included a series of 81 patients 65 years old or older who underwent endoscopic endonasal surgery for pituitary adenomas was analyzed. Pre operative and post operative data were collected and patients were then compared among four age groups: 65–69 years old, 70–74 years old, 75–79 years old and 80 years and over. The results were then compared with the findings from the medical literature review.
Results
The statistical analysis failed to highlight any difference in terms of clinical presentation or complications among the four age groups, however there seems to be a slightly higher risk of post operative hypopituitarism in patients over 74 years old.
Conclusion
The results of the study seem to confirm that transsphenoidal surgery for PA is safe and effective among patients that are 65 and over. Moreover, a partial resection is preferred over a gross total one in order to reduce the surgical risk.
Similar content being viewed by others
Abbreviations
- ACTH:
-
Adrenocorticotrop hormone
- ASA:
-
American Society of Anesthesiologists
- CSF:
-
Cerebrospinal fluid
- DI:
-
Diabetes insipidus
- GH:
-
Growth hormone
- GTR:
-
Gross total resection
- LHS:
-
Length of hospital staying
- NFPA:
-
Non functioning pituitary adenoma
- PA:
-
Pituitary adenoma
- PR:
-
Partial resection
- PTS:
-
Patients
- STR:
-
Subtotal resection
References
Pennacchietti V, Garzaro M, Grottoli S, Pacca P, Garbossa D, Ducati A, Zenga F (2016) Three-dimensional endoscopic endonasal approach and outcomes in sellar lesions: a single-center experience of 104 cases. World Neurosurg 89:121–125. https://doi.org/10.1016/j.wneu.2016.01.049
Knosp E, Steiner E, Kitz K, Matula C (1993) Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 33:610. https://doi.org/10.1227/00006123-199310000-00008
Owens WD, Felts JA, Spitznagel EL Jr (1978) ASA physical status classifications: a study of consistency of ratings. Anesthesiology 49:239–243
Katznelson L, Laws ER, Melmed JS, Molitch ME, Murad MH, Utz A, Wass JAH (2014) Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 99:3933–3951
Melmed S, Bronstein MD, Chanson P, Klibanski A, Casanueva FF, Wass JAH, Strasburger CJ, Luger A, Clemmons DR, Giustina A (2018) A consensus statement on acromegaly therapeutic outcome. Nat Rev Endocrinol 14:553–560
Park HJ, Ahn ST, Moon DG (2019) Evolution of guidelines for testosterone replacement therapy. J Clin Med 8(3):410
Davidiuk AJ, Broderick GA (2016) Adult-onset hypogonadism: evaluation and role of testosterone replacement therapy. Transl Androl Urol 5(6):824–833
Pereira EA, Plaha P, Chari A, Paranathala M, Haslam N, Rogers A, Korevaar T, Tran D, Olarinde R, Karavitaki N, Grossman AB, Cudlip SA (2014) Transsphenoidal pituitary surgery in the elderly is safe and effective. Br J Neurosurg 28(5):616–621. https://doi.org/10.3109/02688697.2013.872225
Puchner MJ, Knappe UJ, Ludecke DK (1995) Pituitary surgery in elderly patients with acromegaly. Neurosurgery 36:677–683 (discussion 83–4)
Sasagawa Y, Hayashi Y, Tachibana O, Nakagawa A, Oishi M, Takamura T, Iizuka H, Nakada M (2018) Transsphenoidal surgery for elderly patients with acromegaly and its outcomes: comparison with younger patients. World Neurosurg 118:e229–e234. https://doi.org/10.1016/j.wneu.2018.06.165
Fujimoto K, Yano S, Shinojima N, Hide T, Kuratsu JI (2017) Endoscopic endonasal transsphenoidal surgery for patients aged over 80 years with pituitary adenomas: surgical and follow-up results. Surg Neurol Int 8:213. https://doi.org/10.4103/sni.sni_189_17
Gondim JA, Almeida JP, de Albuquerque LA, Gomes E, Schops M, Mota JI (2015) Endoscopic endonasal transsphenoidal surgery in elderly patients with pituitary adenomas. J Neurosurg 123:31–38. https://doi.org/10.3171/2014.10.JNS14372
Barzaghi LR, Losa M, Giovanelli M, Mortini P (2007) Complications of transsphenoidal surgery in patients with pituitary adenoma: experience at a single centre. Acta Neurochir (Wien) 149:877–885
Ferrante L, Trillo G, Ramundo E, Celli P, Jaffrain-Rea ML, Salvati M, Esposito V, Roperto R, Osti MF, Minniti G (2002) Surgical treatment of pituitary tumors in the elderly: clinical outcome and long-term follow- up. J Neurooncol 60:185–191
Hong J, Ding X, Lu Y (2008) Clinical analysis of 103 elderly patients with pituitary adenomas: transsphenoidal surgery and follow-up. J Clin Neurosci 15:1091–1095. https://doi.org/10.1016/j.jocn.2007.11.003
Turner HE, Stratton IM, Byrne JV, Adams CB (1999) Wass JA Audit of selected patients with nonfunctioning pituitary adenoma treated without irradiation–a follow-up study. Clin Endocrinol (Oxf) 51:281–284
Nemergut EC, Dumont AS, Barry UT, Laws ER (2005) Perioperative management of patients undergoing transsphenoidal pituitary surgery. Anesth Analg 101:1170–1181. https://doi.org/10.1213/01.ane.0000166976.61650.ae
Arafah BM, Kailani SH, Nekl KE, Gold RS, Selman WR (1994) Immediate recovery of pituitary function after transsphenoidal resection of pituitary macroadenomas. J Clin Endocrinol Metab 79:348–354
Kurosaki M, Ludecke DK, Flitsch J, Saeger W (2000) Surgical treatment of clinically non-secreting pituitary adenomas in elderly patients. Neurosurgery 47:843–848 (discussion 848–9)
Robenshtok E, Benbassat CA, Hirsch D, Tzvetov G, Cohen ZR, Iraqi HM, Gorshtein A, Toledano Y, Shimon I (2014) Clinical course and outcome of nonfunctioning pituitary adenomas in the elderly compared with younger age groups. Endocr Pract 20:159–164. https://doi.org/10.4158/EP13182.OR
Minniti G, Esposito V, Piccirilli M, Fratticci A, Santoro A, Jaffrain-Rea ML (2005) Diagnosis and management of pituitary tumours in the elderly: a review based on personal experience and evidence of literature. Eur J Endocrinol 153:723–733. https://doi.org/10.1530/eje.1.02030
Cohen DL, Bevan JS, Adams CB (1989) The presentation and management of pituitary tumors in the elderly. Age Ageing 18:247–252
Fraioli B, Pastore FS, Signoretti S, De Caro GM (1999) Giuffre R The surgical treatment of pituitary adenomas in the eighth decade. Surg Neurol 51:261–266 (discussion 266–7)
Turner HE, Adams CB, Wass JA (1999) Pituitary tumours in the elderly: a 20 year experience. Eur J Endocrinol 140:383–389
Sheehan JM, Douds GL, Hill K, Farace E (2008) Transsphenoidal surgery for pituitary adenoma in elderly patients. Acta Neurochir 150:571–574. https://doi.org/10.1007/s00701-008-1581-2
Grossman R, Mukherjee D, Chaichana KL, Salvatori R, Wand G, Brem H, Chang DC, Quiñones-Hinojosa A (2010) Complications and death among elderly patients undergoing pituitary tumour surgery. Clin Endocrinol (Oxf) 73:361–368. https://doi.org/10.1111/j.1365-2265.2010.03813.x
Locatelli M, Bertani G, Carrabba G, Rampini P, Zavanone M, Caroli M, Sala E, Ferrante E, Gaini SM, Spada A, Mantovani G, Lania A (2013) Trans-sphenoidal resection of pituitary adenomas in elderly patients and surgical risk. Pituitary 16(2):146–151. https://doi.org/10.1007/s11102-012-0390-z
Doczi T, Joo F, Bodosi M (1990) Central neuroendocrine control of the brain water, electrolyte, and volume homeostasis. Acta Neurochir (Wien) 47(Suppl):122–126
Lightman S (1990) Central nervous system control of fluid balance: physiology and pathology. Acta Neurochir (Wien) 47(Suppl):90–94
Rolls BJ, Phillips PA (1990) Ageing and disturbances of thirst and fluid balance. Nutr Rev 48:137–144
Zhan R, Ma Z, Wang D, Li X (2015) Pure endoscopic endonasal transsphenoidal approach for nonfunctioning pituitary adenomas in the elderly: surgical outcomes and complications in 158 patients. World Neurosurg 84:1572–1578. https://doi.org/10.1016/j.wneu.2015.08.035
Yunoue S, Tokimura H, Tominaga A, Fujio S, Karki P, Usui S, Kinoshita Y, Habu M, Moinuddin FM, Hirano H, Arita K (2014) Transsphenoidal surgical treatment of pituitary adenomas in patients aged 80 years or older. Neurosurg Rev 37:269. https://doi.org/10.1007/s10143-013-0509-3
Arafah BM (1986) Reversible hypopituitarism in patients with large nonfunctioning pituitary adenomas. J Clin Endocrinol Metab 62:1173–1179
Berker M, Hazer DB, Yucel T, Gurlek A, Cila A, Aldur M, Onerci M (2012) Complications of endoscopic surgery of the pituitary adenomas: analysis of 570 patients and review of the literature. Pituitary 15:288–300. https://doi.org/10.1007/s11102-011-0368-2
Cavallo LM, Dal Fabbro M, Jalaloddin H, Messina A, Esposito I, Esposito F, de Divitiis E, Cappabianca P (2007) Endoscopic endonasal transsphenoidal surgery. Before scrubbing in: tips and tricks. Surg Neurol 67:342–347. https://doi.org/10.1016/j.surneu.2006.09.040
Frank G, Pasquini E (2006) Endoscopic endonasal cavernous sinus surgery, with special reference to pituitary adenomas. Front Horm Res 34:64–82. https://doi.org/10.1159/000091573
Mamelak AN, Carmichael J, Bonert VH, Cooper O, Melmed S (2013) Single-surgeon fully endoscopic endonasal transsphenoidal surgery: outcomes in three-hundred consecutive cases. Pituitary 16:393–401. https://doi.org/10.1007/s11102-012-0437-1
Harris PE, Afshar F, Coates P, Doniach I, Wass JA, Besser GM, Grossman A (1989) The effects of trans-sphenoidal surgery on endocrine function and visual fields in patients with functionless pituitary tumours. Q J Med 17:417–427
Kurosaki M, Saeger W, Ludecke DK (2001) Pituitary tumors in the elderly. Pathol Res Pract 197:493–497. https://doi.org/10.1078/0344-0338-00117
Freda PU, Bruce JN (2010) Surgery: risks of pituitary surgery in the elderly. Nat Rev Endocrinol 6:606–608. https://doi.org/10.1038/nrendo.2010.170
Funding
This research did not receive any specific Grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All the authors declared that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Tardivo, V., Penner, F., Garbossa, D. et al. Surgical management of pituitary adenomas: does age matter?. Pituitary 23, 92–102 (2020). https://doi.org/10.1007/s11102-019-01014-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11102-019-01014-1