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Pituitary surgery in elderly patients: a safe and effective procedure

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Abstract

Purpose

The incidence of pituitary adenoma (PA) increases with age. Transsphenoidal surgery (TSS) in elderly patients is often considered to have greater risk compared to the younger population. The aim of this study is to compare surgical results, evolution and postoperative complications between elderly and young patients undergoing TSS.

Methods

Retrospective review of patients undergoing TSS between 2011 and 2018 in our institution. Patients were divided into two cohorts: elderly (≥65 years) and non-elderly (<65 years). Characteristics and outcomes of both groups were compared at diagnosis, before surgery and for an average of 5.9 years of postoperative follow-up.

Results

One hundred and twenty-five patients were included, 53 patients were ≥65 years (42%). The elderly patients were more likely to have non-functioning PA (NFPA) (90.5% vs. 45.8%, p: <0.01), a higher proportion of macroadenomas (92.4% vs. 77.8%, p = 0.029) and greater extrasellar extension (88.7% vs. 68.1%, p = 0.007). The elderly group also had more compressive symptoms (54.7% vs. 34.7%, p = 0.035) and hypopituitarism (66% vs. 47.2%, p = 0.029). Overall, surgical and endocrinological outcomes between the two groups were similar. Inpatient mortality in the elderly group was 1.8%. Regarding long-term outcomes, elderly patients had more postoperative hypopituitarism (67.9% vs. 45.8%, p = 0.03) with no differences in permanent diabetes insipidus, less residual tumours (24.5% vs. 40.3%, p = 0.019) and a higher rate of remission after surgery (71.7% vs. 52.8%, p = 0.034). When only NFPA cases were compared, the only significant difference was a higher frequency of macroadenomas in the elderly group.

Conclusions

Our results support the safety and efficacy of TSS in elderly patients with PA. Age should not be considered an exclusion criterion for TSS given that successful results can be achieved if an experienced pituitary team is available.

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Funding

This study was supported by national grants from Agencia Estatal de Investigación and Instituto de Salud Carlos III, with participation of European FEDER funds, to I.B. (PI/20–01024).

Author contributions

All authors contributed to the study conception and design. Data collection was performed by R.V.T., C.D.O., M.S.D., A.F.P. and R.S.G. Data analysis was performed by R.V.T. and A.F.P. The first draft of the paper was written by R.V.T., C.D.O., M.S.D. and A.F.P. All authors commented on previous versions of the paper and read and approved the final paper.

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Authors and Affiliations

  1. Endocrinology Department, University Hospital of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain

    R. Villar-Taibo, A. Fernández-Pombo & I. Bernabeu

  2. Neoplasia and Differentiation of Endocrine Cells Group, Instituto de Investigación Sanitaria-IDIS (Health Research Institute), Santiago de Compostela (A Coruña), Spain

    R. Villar-Taibo, R. Serramito-García & I. Bernabeu

  3. Endocrinology Department, University Hospital of A Coruña, A Coruña (A Coruña), Spain

    C. Díaz-Ortega

  4. Endocrinology Department, Mateu Orfila General Hospital, Menorca (Balearic Islands), Spain

    M. Sifontes-Dubon

  5. Neurosurgery Department, University Hospital of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain

    R. Serramito-García

  6. Otolaryngology Department, University Hospital of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain

    G. Martínez-Capoccioni

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  1. R. Villar-Taibo
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Corresponding author

Correspondence to R. Villar-Taibo.

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The authors declare no competing interests.

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The Ethics and Clinical Research Committee of our hospital approved the study protocol.

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Villar-Taibo, R., Díaz-Ortega, C., Sifontes-Dubon, M. et al. Pituitary surgery in elderly patients: a safe and effective procedure. Endocrine 72, 814–822 (2021). https://doi.org/10.1007/s12020-021-02665-6

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  • DOI: https://doi.org/10.1007/s12020-021-02665-6

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