Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy.
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
Endocrine. 2021 Jun;72(3):915-922. doi: 10.1007/s12020-020-02554-4. Epub 2020 Nov 26.
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.
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.
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).
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.
随着预期寿命的延长和影像学技术的广泛应用，老年人垂体腺瘤的治疗已成为一个重要的临床问题。在这项单中心回顾性研究中，我们研究了年龄对接受经鼻蝶窦（TNS）手术治疗垂体腺瘤的患者围手术期和术后结果的影响。
共纳入 169 例（男性占 62%）接受内镜经蝶窦（TNS）手术治疗无功能垂体腺瘤（NFPAs）的患者。根据年龄三分位将患者分为三组：≤56 岁（第 1 组）、57-69 岁（第 2 组）和≥70 岁（第 3 组）。评估并比较三组患者的术后和内分泌学结果。
37/169 例（21.9%）患者至少发生 1 种围手术期并发症，但与患者年龄（P=0.838）、Charlson 合并症评分（P=0.326）和美国麻醉医师协会评分（P=0.616）无关。多变量回归分析显示，腺瘤大小是围手术期并发症的唯一决定因素（比值比 [OR] 1.07，95%置信区间 [CI] 1.00-1.13；P=0.044）。12.2%和 14.2%的患者分别出现和恢复至少 1 种垂体激素缺乏。新发生的垂体激素缺乏风险与磁共振成像（MRI）评估的海绵窦侵犯相关（危险比 [HR] 4.19，95%CI 1.39-12.66；P=0.010），而至少 1 种垂体激素缺乏恢复正常的可能性与患者年龄较小显著相关（HR 0.27，95%CI 0.12-0.61；P=0.002）。
本研究结果进一步证实，即使在合并症和高麻醉风险的情况下，内镜 TNS 手术也是老年 NFPA 患者的安全治疗选择。
