Impact of age on postsurgical outcomes of nonfunctioning pituitary adenomas

被引:13
作者
Biamonte, E. [1 ,2 ]
Betella, N. [1 ]
Milani, D. [3 ]
Lasio, G. B. [3 ]
Ariano, S. [1 ,2 ]
Radice, S. [3 ]
Lavezzi, E. [1 ]
Mazziotti, G. [1 ,2 ]
Lania, A. [1 ,2 ]
机构
[1] Humanitas Clin & Res Ctr IRCCS, Endocrinol Diabetol & Androl Unit, Rozzano, MI, Italy
[2] Humanitas Univ, Dept Biomed Sci, Pieve Emanuele, MI, Italy
[3] Humanitas Clin & Res Ctr IRCCS, Neurosurg Unit, Rozzano, MI, Italy
关键词
Pituitary; Adenoma; Surgery; Age; Complications; SURGICAL-TREATMENT; TRANSSPHENOIDAL SURGERY; ELDERLY-PATIENTS; TUMORS; MANAGEMENT; COMPLICATIONS; MACROADENOMAS; MORTALITY;
D O I
10.1007/s12020-020-02554-4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:915 / 922
页数:8
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