Abstract
Purpose
To assess and compare outcome of surgical management of non-functioning pituitary adenohypophyseal tumours in patients under 65-years, and 65-years and older at tertiary neurosurgical referral centre.
Methods
Data was retrospectively analysed from pituitary database. Forty-four patients aged 65 or older (Group 1) and 93 patients under 65 (Group 2) underwent endoscopic trans-sphenoidal surgery (ETSS) between January 2017 and July 2019. The surgical, endocrinological, ophthalmological and radiological outcomes were compared.
Results
6.8% of Group 1 patients had peri-operative surgical complications compared to 12.9% in Group 2 (p = 0.29). Improved visual fields and acuity were seen in 65.2% and 82.8% of Group 1 and Group 2 respectively (p = 0.124), although there were pre-existing ocular problems in 15.9% of Group 1. New hormone deficiencies were observed in 31.8% of Group 1 patients, and 24.7% of Group 2 (p = 0.555). Tumour regrowth/recurrence was seen in 2.3% of Group 1 (p = 0.553). The rate of repeat surgery was 6.8% in the Group 1 and 12.9% in Group 2 (p = 0.28). There was no significant relationship between extent of resection, complications or hormonal deficiency. The mean duration of follow-up was 10.5 ± 13.0 months for Group 1 patients and 13.0 ± 16.0 months for Group 2 patients (p = 0.526).
Conclusions
ETSS for non-functioning pituitary adenohypophyseal tumours is safe and well tolerated in the patients aged 65 and older. Advanced age by itself should not be a contra-indication for ETSS. It is however highly recommended that the care of such patients to be offered at a high volume, dedicated pituitary surgical units.
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Data availability
This study was registered as a clinical audit and approved by the local hospital institutional review board. Ethics approval was not required as this was not a clinical trial requiring consent from human subjects. No patient derived images, video clips or articles were used in this study.
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Acknowledgements
We would like to thank Mr. Calvin Heal for his input and assistance with the statistical analysis section of this paper.
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B.L.Q., A.E.B., K.K.: Substantial contribution to the conception and design of the study and draughting the manuscript. A.E.B., B.L.Q., F.R., H.V.: Acquisition of data. A.E.B., B.L.Q.: Analysis, and interpretation of data. K.G., O.P., F.R., T.K., J.B.: Critical revision of the manuscript for relevant intellectual content. K.K.: Critical revision of the manuscript and agreement to be accountable for accuracy and integrity of the study. Final approval of the version to be published.
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Quah, B.L., Edwards-Bailey, A., Gnanalingham, K. et al. Endoscopic transsphenoidal surgery for biochemically and clinically non-functioning adenohypophyseal tumours in the elderly: experience from a single UK centre. Endocrine 75, 872–882 (2022). https://doi.org/10.1007/s12020-021-02910-y
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DOI: https://doi.org/10.1007/s12020-021-02910-y