Impact of age on postsurgical outcomes of nonfunctioning pituitary adenomas

• Published in: Endocrine 2021-06, Vol.72 (3), p.915-922
• Main Authors: Biamonte, E., Betella, N., Milani, D., Lasio, G. B., Ariano, S., Radice, S., Lavezzi, E., Mazziotti, G., Lania, A.
• Format: Article
• Language: English
• Subjects: Adenoma; Age; Diabetes; Endocrine Surgery; Endocrinology; Endoscopy; Humanities and Social Sciences; Internal Medicine; Life span; Magnetic resonance imaging; Medicine; Medicine & Public Health; Morbidity; multidisciplinary; Patients; Pituitary; Pituitary hormones; Science; Surgery; Tumors
• ISSN: 1355-008X; 1559-0100
• DOI: 10.1007/s12020-020-02554-4

Purpose The management of pituitary adenomas in the elderly has become a relevant clinical issue, in relationship with improved life expectancy and spreading use of imaging techniques. In this single-center and retrospective study, we investigated the impact of age on peri- and postsurgical outcomes in patients undergoing transnasal sphenoidal (TNS) surgery for pituitary adenomas. Methods One-hundred-sixty-nine patients (62% males) undergoing endoscopic transphenoidal (TNS) surgery for nonfunctioning pituitary adenomas (NFPAs) were enrolled. Patients were subdivided into three groups according to age tertiles: ≤56 (group 1), 57–69 (group 2), and ≥70 (group 3) years. Postsurgical and endocrinological outcomes were evaluated and compared among the three age groups. Results 37/169 patients (21.9%) developed at least one perisurgical complication, without significant association with the patients’ age ( P  = 0.838), Charlson co-morbidity score ( P  = 0.326), and American Society of Anesthesiologist score ( P  = 0.616). In the multivariate regression analysis, the adenoma size resulted the only determinant of perisurgical complication (odds ratio [OR] 1.07, 95% confidence interval [C.I.] 1.00–1.13; P  = 0.044). The development and the recovery of at least one pituitary hormone deficiency were observed in 12.2% and 14.2% of patients, respectively. The risk of developing new pituitary hormone deficiencies was correlated with cavernous sinus invasion as evaluated by magnetic resonance imaging (hazard ratio [HR] 4.19, 95% C.I. 1.39–12.66; P  = 0.010), whereas the probability to normalize at least one pituitary hormone deficiency was significantly correlated with younger age of patients (HR 0.27, 95% CI 0.12–0.61; P  = 0.002). Conclusions The results of this study reinforce the concept that endoscopic TNS surgery is a safe therapeutic option in the elderly patients with NFPA, even in presence of comorbidities and high anesthetic risk.