Impact of age on postsurgical outcomes of nonfunctioning pituitary adenomas
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ENDOCRINE SURGERY
Impact of age on postsurgical outcomes of nonfunctioning pituitary adenomas E. Biamonte1,2 N. Betella1 D. Milani3 G. B. Lasio3 S. Ariano1,2 S. Radice3 E. Lavezzi1 G. Mazziotti A. Lania1,2 ●
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Received: 17 October 2020 / Accepted: 11 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract 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. Keywords Pituitary Adenoma Surgery Age Complications ●
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Introduction
These authors contributed equally: E. Biamonte, N. Betella * G. Mazziotti [email protected] 1
Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy
2
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
3
Neurosurgery Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy
Pituitary adenomas (PAs) are the third most common intracranial tumors [1, 2] and are frequently diagnosed in the elderly [3–12], in relationship with the global aging of population and advances in diagnostic techniques. Noteworthy, most of PAs in
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