Endocrinology Department, University Hospital of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain.
Neoplasia and Differentiation of Endocrine Cells Group, Instituto de Investigación Sanitaria-IDIS (Health Research Institute), Santiago de Compostela (A Coruña), Spain.
Endocrine. 2021 Jun;72(3):814-822. doi: 10.1007/s12020-021-02665-6. Epub 2021 Mar 4.
The incidence of pituitary adenoma (PA) increases with age. Transsphenoidal surgery (TSS) in elderly patients is often considered to have greater risk compared to the younger population. The aim of this study is to compare surgical results, evolution and postoperative complications between elderly and young patients undergoing TSS.
Retrospective review of patients undergoing TSS between 2011 and 2018 in our institution. Patients were divided into two cohorts: elderly (≥65 years) and non-elderly (<65 years). Characteristics and outcomes of both groups were compared at diagnosis, before surgery and for an average of 5.9 years of postoperative follow-up.
One hundred and twenty-five patients were included, 53 patients were ≥65 years (42%). The elderly patients were more likely to have non-functioning PA (NFPA) (90.5% vs. 45.8%, p: <0.01), a higher proportion of macroadenomas (92.4% vs. 77.8%, p = 0.029) and greater extrasellar extension (88.7% vs. 68.1%, p = 0.007). The elderly group also had more compressive symptoms (54.7% vs. 34.7%, p = 0.035) and hypopituitarism (66% vs. 47.2%, p = 0.029). Overall, surgical and endocrinological outcomes between the two groups were similar. Inpatient mortality in the elderly group was 1.8%. Regarding long-term outcomes, elderly patients had more postoperative hypopituitarism (67.9% vs. 45.8%, p = 0.03) with no differences in permanent diabetes insipidus, less residual tumours (24.5% vs. 40.3%, p = 0.019) and a higher rate of remission after surgery (71.7% vs. 52.8%, p = 0.034). When only NFPA cases were compared, the only significant difference was a higher frequency of macroadenomas in the elderly group.
Our results support the safety and efficacy of TSS in elderly patients with PA. Age should not be considered an exclusion criterion for TSS given that successful results can be achieved if an experienced pituitary team is available.
垂体腺瘤（PA）的发病率随年龄增长而增加。与年轻人群相比，老年患者行经蝶窦手术（TSS）往往被认为风险更大。本研究旨在比较 TSS 治疗老年和年轻患者的手术结果、演变和术后并发症。
回顾性分析 2011 年至 2018 年期间在我院行 TSS 的患者。患者分为两组：老年组（≥65 岁）和非老年组（<65 岁）。比较两组患者在诊断时、手术前以及平均 5.9 年的术后随访期间的特征和结果。
共纳入 125 例患者，其中 53 例患者≥65 岁（42%）。老年患者更有可能患有无功能垂体腺瘤（NFPA）（90.5% vs. 45.8%，p：<0.01）、大腺瘤（92.4% vs. 77.8%，p=0.029）和更广泛的鞍外扩展（88.7% vs. 68.1%，p=0.007）。老年组也有更多的压迫症状（54.7% vs. 34.7%，p=0.035）和垂体功能减退症（66% vs. 47.2%，p=0.029）。总体而言，两组患者的手术和内分泌学结果相似。老年组的住院死亡率为 1.8%。关于长期结果，老年患者术后发生垂体功能减退症的比例更高（67.9% vs. 45.8%，p=0.03），永久性尿崩症无差异，肿瘤残留较少（24.5% vs. 40.3%，p=0.019），术后缓解率更高（71.7% vs. 52.8%，p=0.034）。仅比较 NFPA 病例时，老年组仅发现大腺瘤的发生率更高。
我们的结果支持 TSS 治疗老年 PA 患者的安全性和有效性。如果有经验丰富的垂体团队，年龄不应作为 TSS 的排除标准，因为可以获得成功的结果。
