Pituitary Adenomas
Because of the increasing life expectancy and improving of diagnostic methods, management of pituitary adenomas in elderly patients is growing with time and, actually, the incidence rate has reached value of 7–10 %; more than 80 % of these lesions result
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Pituitary Adenomas Paolo Cappabianca, Chiara Caggiano, Domenico Solari, Karol Migliorati, Waleed A. Azab, Elia Guadagno, Marialaura Del Basso De Caro, Emmanuel Jouanneau, and Luigi M. Cavallo
Abbreviations ACTH Adrenocorticotropin ASA American Society of Anesthesiologists AVP Arginine vasopressin CAD Coronary artery disease CSF Cerebrospinal fluid DI Diabetes insipidus FSH Follicle-stimulating hormone GH Growth hormone GTR Gross total removal IHD Ischemic heart disease LH Luteinizing hormone NFPA Non-functioning pituitary adenoma PA Pituitary adenoma
P. Cappabianca, MD (*) • C. Caggiano, MD • D. Solari, MD, PhD K. Migliorati, MD • L.M. Cavallo, MD, PhD Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Via Pansini 5, 80131 Naples, Italy e-mail: [email protected] W.A. Azab, MD Department of Neurosurgery, Ibn Sina Hospital, Kuwait city, Kuwait E. Guadagno, MD • M.D.B. De Caro, BS Department of Advanced Biomedical Sciences, Università degli Studi di Napoli Federico II, Naples, Italy E. Jouanneau, MD, PhD Department of Neurosurgery, University Hospital of Lyon – Hospices Civils de Lyon, Lyon, France © Springer International Publishing Switzerland 2017 M. Berhouma, P. Krolak-Salmon (eds.), Brain and Spine Surgery in the Elderly, DOI 10.1007/978-3-319-40232-1_9
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PRL Prolactin SIADH Syndrome of inappropriate antidiuretic hormone STR Subtotal removal TSH Thyroid-stimulating hormone VDF Visual field deficit
9.1
Introduction
Pituitary adenomas (PA) are histological benign tumours of the adenohypophysis, representing the third most frequent intracranial neoplasia [1], with equal distribution in children, adults and elderly patients. These lesions can be identified as functioning or non-functioning adenomas according to the secretion of one or more pituitary hormones by the tumour mass. Diagnosis is easily ruled out in the cases of secreting lesions, upon the clinical features of hypersecretion that define a specific phenotypic syndrome, such as Cushing disease or acromegaly; conversely, in cases of non-functioning tumours, lesions are diagnosed when symptoms due to the mass effect, i.e. visual defects and/or oculomotor palsy, become evident. Finally, it should not be underestimated that a certain percentage of patients remain totally asymptomatic, receiving though accidental diagnosis. The frequency of different subtypes of PA differs among age groups: the most common PAs in early childhood are ACTH-secreting; prolactinomas are the most encountered during the second, third and fourth decades of life, while after the age of 40 years, the most frequent are the non-functioning pituitary adenomas (NFPAs). Nowadays, the average life can exceed 75 years in the developed countries and may increase in the future decades, with the threshold of elderly being considered 65 years. The incidence of PAs in this group of patients, i.e. the elderly, ranges between 7 and 9.9 % [12]: it is actua
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