Surgical Risk and Outcomes for Pituitary Masses in the Elderly

Abstract

The elderly (≥65 years of age) comprise up to 14% of all patients diagnosed with pituitary adenomas. This cohort of patients is expected to expand with growing life expectancy, increased access to healthcare, and frequent utilization of neuroimaging. Therefore, investigating the safety and efficacy of transsphenoidal surgery in this age group is critical. The current literature consists of several retrospective studies, some with younger control groups, where surgery was performed by an experienced pituitary surgeon. Elderly patients most commonly present with visual dysfunction, hypopituitarism, headaches, or incidental findings on imaging, usually with macroadenomas. Histologically, these tumors are predominantly non-functioning, but with somatotroph tumors being the most common among hyperfunctioning pituitary adenomas. While rates of complete resection are lower in the elderly, rates of recurrence and visual improvement are similar between the young and the old. Complications pertaining to surgery (surgical, medical, and endocrine) are also comparable between both age groups with a few exceptions. The rates of cerebrospinal leaks and diabetes insipidus are less frequent in the elderly, though postoperative hyponatremia is more common. Thus, pituitary surgery in the elderly by an experienced pituitary neurosurgeon can be effective with a low incidence of adverse events.