Wang Run, Han Xiaodi, Xie Cheng, Zhang Qinghua, Kan Liang, Han Sheng
Department of Neurosurgery, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, China.
Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, China.
Front Endocrinol (Lausanne). 2024 Dec 6;15:1385813. doi: 10.3389/fendo.2024.1385813. eCollection 2024.
Pituitary adenomas (PAs) present with clinical features such as neuroendocrine abnormalities and mass effects, common in the general morbidity population. However, in elderly patients, the disease progression renders some clinical features difficult to detect and identify in time. Consequently, elderly patients with PAs are often not identified and receive sufficient intervention on time to achieve a satisfactory outcome.
Clinical data were collected from 114 consecutive patients older than 70 years with PAs who had undergone surgery. Based on the average age, the patients were categorized into a younger group and an elder group, and were statistically analyzed and compared.
Sixty-five males (57.0%) and 49 females (43.0%) were included in the study, with an average age of 73.2 years. Their common preoperative symptoms included vision impairment, followed by headache and vomiting, and visual field defect. The milder the preoperative visual impairment, the greater the possibility of post-operative visual improvement (P=0.001). The tumors were primarily non-functional pituitary adenomas (NFPAs, 73.7%), with a high degree of suprasellar invasion but a low degree of parasellar invasion (P<0.0001). For further analysis, based on the average age, we categorized the patients into younger (age< 73 years, 59 cases) and elder (age≥ 73 years, 55 cases) groups. The elder group was more likely to have preoperative vision impairment problems (P=0.044), whilst post-operative visual improvement was worse (P=0.001). The elder group also had a more severe suprasellar invasion (P=0.009), with a higher proportion of NFPA than the younger group (P=0.006). Compared to the younger group, the tumors in the elder group were larger (P=0.039), and had a higher rate of apoplexy (P=0.039), and were more likely to have comorbid postoperative complications (P=0.031), such as fever and cerebrospinal fluid (CSF) leakage, compared to the younger group.
Elderly patients with PA had specific clinical characteristics. Their relatively worse pre- and post-operative conditions and intraoperative findings illustrated the need for early surgery.
垂体腺瘤（PAs）具有神经内分泌异常和占位效应等临床特征，在普通发病群体中较为常见。然而，在老年患者中，疾病进展使得一些临床特征难以及时检测和识别。因此，老年垂体腺瘤患者往往未能得到及时诊断，也未获得足够的干预以取得满意的治疗效果。
收集了114例年龄大于70岁且接受过手术的垂体腺瘤患者的临床资料。根据平均年龄，将患者分为较年轻组和较年长组，并进行统计分析和比较。
本研究共纳入65例男性（57.0%）和49例女性（43.0%），平均年龄为73.2岁。其常见的术前症状包括视力障碍，其次是头痛、呕吐和视野缺损。术前视力损害越轻，术后视力改善的可能性越大（P = 0.001）。肿瘤主要为无功能垂体腺瘤（NFPAs，73.7%），鞍上侵犯程度高，但鞍旁侵犯程度低（P < 0.0001）。为进一步分析，根据平均年龄，我们将患者分为较年轻组（年龄<73岁，59例）和较年长组（年龄≥73岁，55例）。较年长组术前视力障碍问题更常见（P = 0.044），而术后视力改善较差（P = 0.001）。较年长组的鞍上侵犯也更严重（P = 0.009），无功能垂体腺瘤的比例高于较年轻组（P = 0.006）。与较年轻组相比，较年长组的肿瘤更大（P = 0.039），卒中发生率更高（P = 0.039），术后合并发热、脑脊液漏等并发症的可能性也更大（P = 0.031）。
老年垂体腺瘤患者具有特定的临床特征。他们相对较差的术前和术后状况以及术中发现表明需要早期手术。
