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Surgical Treatment of Pituitary Tumors in the Elderly: Clinical Outcome and Long-term Follow-up

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Abstract

Pituitary adenomas in the elderly represent an increasing proportion of pituitary tumors, making the surgical management of these patients of special importance. We therefore decided to review our experience with transsphenoidal surgery (TSS) in this age group, in order to better evaluate its efficacy, safety and outcome.

A retrospective study was performed on 39 patients aged more than 70 years at the time of surgery (mean age 74.1 ± 2.9 years) and with a minimum follow-up duration of 4 years at the time of the study. Thirty-one had a nonfunctioning pituitary adenoma, 5 had a GH-secreting adenoma and 3 a macroprolactinoma, respectively. The commonest presenting symptom was visual deterioration (60%), whereas hypopituitarism were present in 41% of patients. All patients underwent TSS without any major peri- and post-operative complications. Visual fields improved in 74% of patients. Post-operative radiotherapy was performed in 17 patients with partial surgical resection and/or persistent hormonal hypersecretion, whereas 22 patients with subtotal or total surgical resection were treated by surgery only. Long-term follow-up (mean 9.1 ± 2.7 years) showed evidence for tumor regrowth in one irradiated (5.9%) and 3 non-irradiated patients (13.6%), respectively. A noticeable complication of radiotherapy was progressive hypopituitarism, which worsened or developed in 65% of patients.

We conclude that TSS is safe and well tolerated even in elderly patients, with a low incidence of minor complications. The indications for post-operative radiotherapy in patients with incomplete tumor resection should be better defined.

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Authors and Affiliations

  1. Department of Neurological Sciences, Neurosurgery 2, University of Rome ‘La Sapienza’, Rome

    Luigi Ferrante, Giuseppe Trillò, Epimenio Ramundo & Paolo Celli

  2. Department of Experimental Medicine, University of L'Aquila, Coppito 2, L'Aquila, Italy

    Marie-Lise Jaffrain-Rea

  3. Division of Neurosurgery, Mediterranean Neurological Institute (NEUROMED-IRCCS), University of Rome ‘La Sapienza’, Pozzilli

    Maurizio Salvati, Vincenzo Esposito, Raffaele Roperto & Giuseppe Minniti

  4. Division of Radiotheraphy Oncology, University of Rome ‘La Sapienza’, Rome

    Mattia Falchetto Osti

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Ferrante, L., Trillò, G., Ramundo, E. et al. Surgical Treatment of Pituitary Tumors in the Elderly: Clinical Outcome and Long-term Follow-up. J Neurooncol 60, 185–191 (2002). https://doi.org/10.1023/A:1020652604014

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