Comparison of Pituitary Adenomas in Elderly and Younger Adults: Clinical Characteristics, Surgical Outcomes, and Prognosis

Liu, Junfeng; Li, Chaoxi; Xiao, Qungen; Gan, Chao; Chen, Xi; Sun, Wei; Li, Xiaopeng; Xu, Yu; Chen, Juan; Shu, Kai; Lei, Ting

doi:10.1111/jgs.13590

Cited by 39 publications

(25 citation statements)

References 31 publications

(63 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The recovery rate for corticotropic axis ranges from 0% to 57%, for thyrotropic axis from 13% to 57%, for gonadotropic axis from 11% to 32%, and for somatotropic axis from 15% to 40% . The rate of hypopituitarism after transsphenoidal surgery in elderly adults seems to be higher . The endoscopic approach showed a reduced rate of postoperative occurrence of hypopituitarism in comparison to the microscopic approach.…”

Section: Intradural Tumorsmentioning

confidence: 92%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

137

260

View full text Add to dashboard Cite

Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

show abstract

Section: Intradural Tumorsmentioning

confidence: 92%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

137

260

View full text Add to dashboard Cite

show abstract

“…Most pituitary tumours in this age group are large, slowly growing invasive tumours (179,180). Low growth rate of tumour remnants is reported by some (in 21% of the patients despite subtotal and partial tumour resections), while other authors report progression rates comparable in elderly and young patients (178,179,180). There is no absolute contraindication to either radiotherapy or oncological drugs in the elderly.…”

Section: Special Circumstances a Paediatricmentioning

confidence: 93%

“…Elderly Pituitary tumours in the elderly (patients older than 65 (176) are mostly clinically non-functioning (NFPA), although in general, they stain positive for gonadotroph hormones (177,178). Most pituitary tumours in this age group are large, slowly growing invasive tumours (179,180). Low growth rate of tumour remnants is reported by some (in 21% of the patients despite subtotal and partial tumour resections), while other authors report progression rates comparable in elderly and young patients (178,179,180).…”

Section: Special Circumstances a Paediatricmentioning

confidence: 99%

European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas

Raverot

Burman

McCormack

et al. 2018

European Journal of Endocrinology

418

471

View full text Add to dashboard Cite

Background: Pituitary tumours are common and easily treated by surgery or medical treatment in most cases. However, a small subset of pituitary tumours does not respond to standard medical treatment and presents with multiple local recurrences (aggressive pituitary tumours) and in rare occasion with metastases (pituitary carcinoma). The present European Society of Endocrinology (ESE) guideline aims to provide clinical guidance on diagnosis, treatment and follow-up in aggressive pituitary tumours and carcinomas. Methods: We decided upfront, while acknowledging that literature on aggressive pituitary tumours and carcinomas is scarce, to systematically review the literature according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The review focused primarily on first-and second-line treatment in aggressive pituitary tumours and carcinomas. We included 14 single-arm cohort studies (total number of patients = 116) most on temozolomide treatment (n = 11 studies, total number of patients = 106). A positive treatment effect was seen in 47% (95% CI: 36-58%) of temozolomide treated. Data from the recently performed ESE survey on aggressive pituitary tumours and carcinomas (165 patients) were also used as backbone for the guideline. In patients responding to first-line temozolomide, we suggest continuing treatment for at least 6 months in total. Furthermore, the guideline offers recommendations for patients who recurred after temozolomide treatment, for those who did not respond to temozolomide and for patients with systemic metastasis.

show abstract

“…In this series, visual deterioration was observed in only 1.5% of the total group and the authors suggested that visual deficits should not result in very elderly patients being denied surgery (40). Review of seven further studies on post-operative visual outcomes in patients aged from ≥65 to ≥80 years showed improvement in 34-92%, stability in 3-63% and deterioration in 0-8%, and comparison with various control groups (ranging in age from 18 to <80 years) demonstrated no difference in visual improvement rates (39,40,41,42,43,44,45).…”

Section: Visual Improvement and Factors Affecting Itmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Visual morbidity in patients with pituitary adenoma

Lithgow

Batra

Matthews

et al. 2019

European Journal of Endocrinology

View full text Add to dashboard Cite

Visual dysfunction is an important element in the morbidity encountered in patients with pituitary adenoma leading to functional impairment and compromised quality of life. It consists of many parameters (even in the absence of reported symptomatology) as a result of tumour growth in proximity to structures critical for vision (anterior visual pathway, cranial nerves within cavernous sinuses), and as an adverse consequence of therapeutic interventions. Adenoma resection leads to high rates of visual improvement and possibly continues beyond a year post surgery, but the exact timing of maximum effect requires elucidation. Retinal nerve fibre layer measurement may be a reliable, objective parameter predicting favourable visual outcomes, although its prognostic value when pathological, needs to be confirmed. For compromised vision after pituitary apoplexy, early surgical decompression remains usual practice until evidence-based guidance becomes available. The risk of radiation-induced visual toxicity is mainly influenced by total and per fraction dose of radiation and treatment modality. Careful selection of cases and of radiotherapy technique/planning are of major importance in minimising this risk. Dopamine agonists lead to visual recovery in a considerable number of prolactinoma patients. Visual morbidity should be considered a vital indicator in the metrics of quality of service/care in pituitary disease making regular, full ophthalmic examination an essential component of modern management of pituitary pathology at all time points of patient pathway. Well-designed studies minimising effects of bias and using tools and scoring systems reliably reflecting visual status will provide robust evidence on valid prognostication and patient stratification guiding clinical decision making.

show abstract

Comparison of Pituitary Adenomas in Elderly and Younger Adults: Clinical Characteristics, Surgical Outcomes, and Prognosis

Cited by 39 publications

References 31 publications

ICAR: endoscopic skull‐base surgery

ICAR: endoscopic skull‐base surgery

European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas

MANAGEMENT OF ENDOCRINE DISEASE: Visual morbidity in patients with pituitary adenoma

Contact Info

Product

Resources

About