Pituitary surgery in elderly patients: a safe and effective procedure

Villar-Taibo, Rocío; Díaz-Ortega, C.; Sifontes-Dubón, Mildred; Fernández-Pombo, Antía; Serramito-García, R.; Martínez-Capoccioni, Gabriel; Bernabéu, Ignacio

doi:10.1007/s12020-021-02665-6

Cited by 12 publications

(5 citation statements)

References 29 publications

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“…In another study, 48 elderly patients with a nonfunctioning pituitary adenoma were studied. Their study found a macroadenoma rate of 92%, extrasellar extension of 88%, and postoperative hypopituitarism of 67% (15). Similarly, in our study, the majority of patients had macroadenoma.…”

Section: Discussionsupporting

confidence: 85%

Life Activities of Elderly Patients With Operated Nonfunctional Pituitary Adenoma

kara,

Avcı,

Melikoglu

et al. 2023

Preprint

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Aim To evaluate the clinical findings of nonfunctional pituitary adenomas (NFA) in the geriatric population, functional status, cognitive function, quality of life and frailty. Material-Method We evaluated operated NFA cases aged 65 years and older followed up in our clinic between 2010 and 2022. Patients seen in the geriatric outpatient clinic with a diagnosis of hypertension and diabetes mellitus were included in the study as a control group. Bioimpedance was used to assess muscle strength, walking speed, and muscle to fat ratio in patients. In addition, quality of life, anxiety, depression, cognitive function, and frailty were assessed. Results The study included 43 patients with NFA and 60 patients with hypertension (HT) and type 2 diabetes mellitus (DM) diagnoses. The mean age, sex ratios and body mass index (BMI) of the patients with NFA and the control group diagnosed with HT and type 2 DM were similar (age: 70.9±0.66; 73.1±0.8 (p=0,6), FM /M: 24/19, 35/25 (p=0.1) and BMI:28.3±3.9/28.5±4.8 (p=0.9), respectively). Cognition status (MMT: 28;29, p=0.002), frailty scores (2[2-3]; 1[1-2], M[IQR], p<0.001), sarcopenia rates (62%; 30%, p=0.007) was worse in patients with NFA. Conclusion In the study comparing patients diagnosed with surgical pituitary NFA with patients of similar age and comorbidity, the frailty score and rate of sarcopenia were higher and their cognition was worse. Complications arising from surgical and postoperative treatment of patients with pituitary NFA make geriatric patients more frail. We emphasize that patients with NFA in this age group should be examined more carefully.

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Section: Discussionsupporting

confidence: 85%

Life Activities of Elderly Patients With Operated Nonfunctional Pituitary Adenoma

kara,

Avcı,

Melikoglu

et al. 2023

Preprint

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“…Indeed, a backward-looking analysis based on a U.S. database from 1998 to 2005 reported a higher mortality rate among older patients in the perioperative period than among younger patients ( 5 ). However, in recent studies, TSS was shown to have relatively low invasiveness, and no increased surgical risk was observed in older patients compared to younger patients ( 27 ). In fact, our patient showed no obvious complications during surgery.…”

Section: Discussionmentioning

confidence: 99%

Correction of Hypercortisolemia with an Improved Cognitive Function and Muscle Mass after Transsphenoidal Surgery in an Older Patient with Cushing's Disease

et al. 2022

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Cushing's disease causes numerous metabolic disorders, cognitive decline, and sarcopenia, leading to deterioration of the general health in older individuals. Cushing's disease can be treated with transsphenoidal surgery, but thus far, surgery has often been avoided in older patients. We herein report an older woman with Cushing's disease whose cognitive impairment and sarcopenia improved after transsphenoidal surgery. Although cognitive impairment and sarcopenia in most older patients show resistance to treatment, our case indicates that normalization of the cortisol level by transsphenoidal surgery can be effective in improving the cognitive impairment and muscle mass loss caused by Cushing's disease.

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“…Furthermore, compared with younger subjects, patients >65 years have a higher frequency of macroadenomas, compressive symptoms and hypopituitarism, both before and after surgery. 8 Therefore, in the elderly visual deterioration and hypopituitarism remain the leading symptoms associated to the presence of pituitary macroadenomas. 9 Several mechanisms are involved in the development of hypopituitarism related to macroadenomas, including compression of the pituitary stalk resulting in decreased availability of hypothalamic stimulatory hormones, compression and/or destruction of functioning pituitary tissue, and hypothalamic involvement by the pituitary tumor.…”

Section: Causes Of Hypopituitarism In the Elderlymentioning

confidence: 99%

Treating Hypopituitarism in the Over 65s: Review of Clinical Studies

Paragliola¹,

Locantore²,

Corsello³

et al. 2023

CIA

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The current increase of life expectancy is associated with the presence of endocrine diseases in the elderly. The management of hypopituitarism in this group of patients is a challenging task. A correct diagnosis, which represents an essential requisite for an appropriate medical treatment, can be difficult because of the physiological changes occurring in pituitary function with aging, which may lead to challenges in the interpretation of laboratory results. Furthermore, the treatment requires several careful considerations: the need to restore the hormonal physiology with replacement therapies must be balanced with the need to avoid the risks of the over-replacement, especially in the presence of concomitant cardiovascular and metabolic disease. Interactions with other drugs able to modify the absorption and/or the metabolism of hormonal replacement therapies should be considered, in particular for the treatment of hypoadrenalism and hypothyroidism. The most important challenges stem from the lack of specific studies focused on the management of hypopituitarism in older people.

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Pituitary surgery in elderly patients: a safe and effective procedure

Cited by 12 publications

References 29 publications

Life Activities of Elderly Patients With Operated Nonfunctional Pituitary Adenoma

Life Activities of Elderly Patients With Operated Nonfunctional Pituitary Adenoma

Correction of Hypercortisolemia with an Improved Cognitive Function and Muscle Mass after Transsphenoidal Surgery in an Older Patient with Cushing's Disease

Treating Hypopituitarism in the Over 65s: Review of Clinical Studies

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