Pituitary adenomas in older adults (≥ 65 years) : 90-day outcomes and readmissions: a 10-year endoscopic endonasal surgical experience
INTRODUCTION: Longer lifespan and newer imaging protocols have led to more older adults being diagnosed with pituitary adenomas. Herein, we describe outcomes of patients ≥ 65 years undergoing endoscopic adenoma removal. To address selection criteria, we also assess a conservatively managed cohort.
METHODS: A retrospective analysis of 90-day outcomes of patients undergoing endoscopic pituitary adenomectomy from 2010 to 2019 by a neurosurgical/ENT team was performed. Tumor subtype, cavernous sinus invasion, extent of resection/early remission, endocrinology outcomes, complications, re-operations and readmissions were analyzed. A comparator cohort ≥ 65 years undergoing clinical surveillance without surgery was also analyzed.
RESULTS: Of 468 patients operated on for pituitary adenoma, 123 (26%) were ≥ 65 years (range 65-93 years); 106 (86.2%) had endocrine-inactive adenomas; 18 (14.6%) had prior surgery. Of 106 patients with endocrine-inactive adenomas, GTR was achieved in 70/106 (66%). Of 17 patients with endocrine-active adenomas, early biochemical remission was: Cushing's 6/8; acromegaly 1/4; prolactinomas 1/5. Gland function recovery occurred in 28/58 (48.3%) patients with various degrees of preoperative hypopituitarism. New anterior hypopituitarism occurred in 3/110 (2.4%) patients; permanent DI in none. Major complications in 123 patients were: CSF leak 2 (1.6%), meningitis 1 (0.8%), vision decline 1 (0.8%). There were no vascular injuries, operative hematomas, anosmia, deaths, MIs, or thromboembolic events. Median length of stay was 2 days. Readmissions occurred in 14/123 (11.3%) patients, 57% for delayed hyponatremia. Intra-cohort analysis by age (65-69, 70-74, 75-79, ≥ 80 years) revealed no outcome differences. Cavernous sinus invasion (OR 7.7, CI 1.37-44.8; p = 0.02) and redo-surgery (OR 8.5, CI 1.7-42.8; p = 0.009) were negative predictors for GTR/NTR. Of 105 patients evaluated for presumed pituitary adenoma beginning in 2015, 72 (69%) underwent surgery, 8 (7%) had prolactinomas treated with cabergoline and 25 (24%) continue clinical surveillance without surgery, including two on new hormone replacement.
CONCLUSION: This study suggests that elderly patients carefully selected for endoscopic adenoma removal can have excellent short-term outcomes including high resection rates, low complication rates and short length of stay. Our experience supports a multidisciplinary approach and the concept of pituitary centers of excellence. Based on our observations, approximately 25% of elderly patients with pituitary adenomas referred for possible surgery can be monitored closely without surgery.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:24 |
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| Enthalten in: |
Pituitary - 24(2021), 1 vom: 16. Feb., Seite 14-26 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Thakur, Jai Deep [VerfasserIn] |
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| Links: |
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| Themen: |
Elderly |
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| Anmerkungen: |
Date Completed 01.11.2021 Date Revised 01.11.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s11102-020-01081-9 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM315082259 |
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| 100 | 1 | |a Thakur, Jai Deep |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Pituitary adenomas in older adults (≥ 65 years) |b 90-day outcomes and readmissions: a 10-year endoscopic endonasal surgical experience |
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| 500 | |a Date Completed 01.11.2021 | ||
| 500 | |a Date Revised 01.11.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a INTRODUCTION: Longer lifespan and newer imaging protocols have led to more older adults being diagnosed with pituitary adenomas. Herein, we describe outcomes of patients ≥ 65 years undergoing endoscopic adenoma removal. To address selection criteria, we also assess a conservatively managed cohort | ||
| 520 | |a METHODS: A retrospective analysis of 90-day outcomes of patients undergoing endoscopic pituitary adenomectomy from 2010 to 2019 by a neurosurgical/ENT team was performed. Tumor subtype, cavernous sinus invasion, extent of resection/early remission, endocrinology outcomes, complications, re-operations and readmissions were analyzed. A comparator cohort ≥ 65 years undergoing clinical surveillance without surgery was also analyzed | ||
| 520 | |a RESULTS: Of 468 patients operated on for pituitary adenoma, 123 (26%) were ≥ 65 years (range 65-93 years); 106 (86.2%) had endocrine-inactive adenomas; 18 (14.6%) had prior surgery. Of 106 patients with endocrine-inactive adenomas, GTR was achieved in 70/106 (66%). Of 17 patients with endocrine-active adenomas, early biochemical remission was: Cushing's 6/8; acromegaly 1/4; prolactinomas 1/5. Gland function recovery occurred in 28/58 (48.3%) patients with various degrees of preoperative hypopituitarism. New anterior hypopituitarism occurred in 3/110 (2.4%) patients; permanent DI in none. Major complications in 123 patients were: CSF leak 2 (1.6%), meningitis 1 (0.8%), vision decline 1 (0.8%). There were no vascular injuries, operative hematomas, anosmia, deaths, MIs, or thromboembolic events. Median length of stay was 2 days. Readmissions occurred in 14/123 (11.3%) patients, 57% for delayed hyponatremia. Intra-cohort analysis by age (65-69, 70-74, 75-79, ≥ 80 years) revealed no outcome differences. Cavernous sinus invasion (OR 7.7, CI 1.37-44.8; p = 0.02) and redo-surgery (OR 8.5, CI 1.7-42.8; p = 0.009) were negative predictors for GTR/NTR. Of 105 patients evaluated for presumed pituitary adenoma beginning in 2015, 72 (69%) underwent surgery, 8 (7%) had prolactinomas treated with cabergoline and 25 (24%) continue clinical surveillance without surgery, including two on new hormone replacement | ||
| 520 | |a CONCLUSION: This study suggests that elderly patients carefully selected for endoscopic adenoma removal can have excellent short-term outcomes including high resection rates, low complication rates and short length of stay. Our experience supports a multidisciplinary approach and the concept of pituitary centers of excellence. Based on our observations, approximately 25% of elderly patients with pituitary adenomas referred for possible surgery can be monitored closely without surgery | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Elderly | |
| 650 | 4 | |a Endoscopic endonasal | |
| 650 | 4 | |a Hyperprolactinemia | |
| 650 | 4 | |a Hypopituitarism | |
| 650 | 4 | |a Pituitary adenoma | |
| 650 | 4 | |a Transsphenoidal surgery | |
| 700 | 1 | |a Corlin, Alex |e verfasserin |4 aut | |
| 700 | 1 | |a Mallari, Regin Jay |e verfasserin |4 aut | |
| 700 | 1 | |a Huang, Weichao |e verfasserin |4 aut | |
| 700 | 1 | |a Eisenberg, Amalia |e verfasserin |4 aut | |
| 700 | 1 | |a Sivakumar, Walavan |e verfasserin |4 aut | |
| 700 | 1 | |a Krauss, Howard |e verfasserin |4 aut | |
| 700 | 1 | |a Griffiths, Chester |e verfasserin |4 aut | |
| 700 | 1 | |a Rettinger, Sarah |e verfasserin |4 aut | |
| 700 | 1 | |a Cohan, Pejman |e verfasserin |4 aut | |
| 700 | 1 | |a Barkhoudarian, Garni |e verfasserin |4 aut | |
| 700 | 1 | |a Araque, Katherine A |e verfasserin |4 aut | |
| 700 | 1 | |a Kelly, Daniel |e verfasserin |4 aut | |
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