Summary
Background. As the population continues to age, the number of elderly patients with symptomatic pituitary tumours will continue to increase. Little information exists as to the safety of pituitary surgery in this patient population. The current study was undertaken to evaluate the presentation and perioperative risk associated with transsphenoidal surgery in patients over the age of 70.
Methods. A retrospective chart review was undertaken for patients over the age of 70 undergoing transsphenoidal surgery at the Penn State Hershey Medical Center between 1995 and 2005.
Findings. Sixty-four patients over the age of 70 were identified with an average age of 73.4 years (range 70–84). The average follow-up period was 44 months (range 14–104). Symptoms of mass effect were the presenting complaint in 72% of patients while 9% had documentation of growth on imaging studies. Twelve percent presented with a history consistent with apoplexy. Three patients (5%) presented with acromegaly. Post-operative hospital stay averaged 2.6 days (range 2–7). Eight patients had new hormonal deficits post-operatively (1 ACTH, 3 TSH, 2 ACTH/TSH, 2 vasopressin). There were no cardiopulmonary complications and no deaths within 90 days of surgery.
Conclusions. Transsphenoidal surgery can be performed in patients over the age of 70 without undo significant risks. Surgical removal of pituitary adenomas should be considered the mainstay of treatment in elderly patients in whom treatment is necessary. Patients who are medically suitable candidates should be offered surgical resection as would their younger counterparts.
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References
InstitutionalAuthorNameAmerican Society of Anesthesiologists (1963) ArticleTitleNew classification of physical status Anesthesiology 24 111
FG Barker A Klibanski B Swearingen (2003) ArticleTitleTranssphenoidal surgery for pituitary tumours in the United States, 1996–2000: mortality, morbidity, and the effects of hospital and surgeon volume J Clin Endocrinol 88 4709–4719 Occurrence Handle10.1210/jc.2003-030461 Occurrence Handle1:CAS:528:DC%2BD3sXoslemt70%3D
G Becker M Kocher RD Kortmann F Paulsen B Jeremic RP Muller M Bamberg (2002) ArticleTitleRadiation therapy in the multimodal treatment approach of pituitary adenoma Strahlenther Onkol 178 173–186 Occurrence Handle12040754 Occurrence Handle10.1007/s00066-002-0826-x
P Black S Kathiresan W Chung (1998) ArticleTitleMeningioma surgery in the elderly: a case-control study assessing morbidity and mortality Acta Neurochir (Wien) 140 1013–1016 Occurrence Handle10.1007/s007010050209 Occurrence Handle1:STN:280:DyaK1M%2FntlCktw%3D%3D
A Brandes MV Fiorentino (1998) ArticleTitleTreatment of high-grade gliomas in the elderly Oncology 55 1–6 Occurrence Handle9428367 Occurrence Handle10.1159/000011827 Occurrence Handle1:STN:280:DyaK1c%2FovF2lug%3D%3D
L Ferrante G Trillo E Ramundo P Celli ML Jaffrain-Rea M Salvati V Esposito R Roperto MF Osti G Minniti (2002) ArticleTitleSurgical treatment of pituitary tumours in the elderly: clinical outcome and long-term follow-up J Neurooncol 60 185–191 Occurrence Handle12635667 Occurrence Handle10.1023/A:1020652604014
B Fraioli FS Pastore S Signoretti GM De Caro R Giuffre (1999) ArticleTitleThe surgical treatment of pituitary adenomas in the eighth decade Surg Neurol 51 261–266 Occurrence Handle10086489 Occurrence Handle10.1016/S0090-3019(98)00097-4 Occurrence Handle1:STN:280:DyaK1M7osVaqsQ%3D%3D
K Kovacs N Ryan E Hovarth W Singer C Ezrin (1980) ArticleTitlePituitary adenomas in old age J Gerontol 35 16–22 Occurrence Handle6243145 Occurrence Handle1:STN:280:DyaL3c%2FntlWnsg%3D%3D
M Kurosaki DK Ludecke J Flitsch W Saeger (2000) ArticleTitleSurgical treatment of clinically nonsecreting pituitary adenomas in elderly patients Neurosurgery 47 843–848 Occurrence Handle11014423 Occurrence Handle10.1097/00006123-200010000-00009 Occurrence Handle1:STN:280:DC%2BD3cvmt1eksA%3D%3D
F Letournel P Menei G Guy JP Saint-Andre (2003) ArticleTitleTranssphenoidal surgery in the elderly J Am Geriatr Soc 51 729–730 Occurrence Handle12752861 Occurrence Handle10.1034/j.1600-0579.2003.00229.x
AS Lieu SL Howng (1998) ArticleTitleSurgical treatment of intracranial meningiomas in geriatric patients Kaohsiung J Med Sci 14 498–503 Occurrence Handle9780600 Occurrence Handle1:STN:280:DyaK1cvltlyrtw%3D%3D
G Minniti ML Jaffrain-Rea V Esposito A Santoro C Moroni J Lenzi G Tamburrano R Cassone G Cantore (2001) ArticleTitleSurgical treatment and clinical outcome of GH-secreting adenomas in elderly patients Acta Neurochir (Wien) 143 1205–1211 Occurrence Handle10.1007/s007010100015 Occurrence Handle1:STN:280:DC%2BD38%2Fot1yjsw%3D%3D
JY Pierga K Hoang-Xuan L Feuvret JM Simon P Cornu F Baillet JJ Mazeron JY Delattre (1999) ArticleTitleTreatment of malignant gliomas in the elderly J Neurooncol 43 187–193 Occurrence Handle10533732 Occurrence Handle10.1023/A:1006262918694 Occurrence Handle1:STN:280:DC%2BD3c%2FgtFaquw%3D%3D
TA Pietila R Stendel WE Hassler C Heimberger J Ramsbacker M Brock (1999) ArticleTitleBrain tumour surgery in geriatric patients: a critical analysis in 44 patients over 80 years Surg Neurol 52 259–263 Occurrence Handle10511083 Occurrence Handle10.1016/S0090-3019(99)00075-0 Occurrence Handle1:STN:280:DyaK1MvjvFWjsw%3D%3D
J Pospiech D stolke FR Pospiech (1996) ArticleTitleSurgical treatment of pituitary adenomas in elderly patients Acta Neurochir (Wien) 65 35–36 Occurrence Handle1:STN:280:DyaK28zjs1ejsQ%3D%3D
JP Sheehan A Niranjan JM Sheehan JA Jane ER Laws D Kondziolka J Flickinger AM Landolt JS Loeffler LD Lunsford (2005) ArticleTitleStereotactic radiosurgery for pituitary adenomas: an intermediate review of its safety, efficacy, and role in the neurosurgical treatment armamentarium J Neurosurg 102 678–691 Occurrence Handle15871511 Occurrence Handle10.3171/jns.2005.102.4.0678
PJ Snyder (1993) ArticleTitleClinically nonfunctioning pituitary adenomas Endocrinol Metab Clin North Am 22 163–175 Occurrence Handle8449186 Occurrence Handle1:STN:280:DyaK3s7ptlKkug%3D%3D
O Tucha C Smely KW Lange (2001) ArticleTitleEffects of surgery on cognitive functioning in elderly patients with intracranial meningioma Br J Neurosurg 15 184–188 Occurrence Handle11360390 Occurrence Handle10.1080/02688690151127608 Occurrence Handle1:STN:280:DC%2BD3M3nsVWhuw%3D%3D
HE Turner IM Stratton JV Byrne CB Adams JA Wass (1999) ArticleTitleAudit of selected patients with nonfunctioning pituitary adenoma treated without irradiation – a follow-up study Clin Endocrinol (Oxf) 51 281–284 Occurrence Handle10.1046/j.1365-2265.1999.00865.x Occurrence Handle1:STN:280:DC%2BD3c%2Fgt1erug%3D%3D
V Vuorinen S Hinkka M Farkkila J Jaaskelainen (2003) ArticleTitleDebulking or biopsy of malignant glioma in elderly people – a randomised study Acta Neurochir (Wien) 145 5–10 Occurrence Handle10.1007/s00701-002-1030-6 Occurrence Handle1:STN:280:DC%2BD3s%2FjsFGgsA%3D%3D
AC Wollons MK Hunn YR Rajapakse DA Hamilton JV Conaglen V Balakrishnan (2000) ArticleTitleNon-functioning pituitary adenomas: indications for postoperative radiotherapy Clin Endocrinol (Oxf) 53 713–717 Occurrence Handle10.1046/j.1365-2265.2000.01153.x
D Zierhut M Flentje J Adolph J Erdmann F Raue M Wannenmacher (1995) ArticleTitleExternal radiotherapy of pituitary adenomas Int J Radiat Oncol Biol Phys 33 307–314 Occurrence Handle7673017 Occurrence Handle1:STN:280:DyaK2MvgtlWquw%3D%3D
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Correspondence: Jonas M. Sheehan, M.D., Hershey Medical Center, Department of Neurosurgery, Penn State College of Medicine, 500 University Drive, Hershey, 17033 Pennsylvania, USA.
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Sheehan, J., Douds, G., Hill, K. et al. Transsphenoidal surgery for pituitary adenoma in elderly patients. Acta Neurochir (Wien) 150, 571–574 (2008). https://doi.org/10.1007/s00701-008-1581-2
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DOI: https://doi.org/10.1007/s00701-008-1581-2