Surgical Treatment of Clinically Nonsecreting Pituitary Adenomas in Elderly Patients

Kurosaki, Masamichi; Lüdecke, Dieter K.; Flitsch, Jörg; Saeger, Wolfgang

doi:10.1097/00006123-200010000-00009

Cited by 65 publications

(30 citation statements)

References 21 publications

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“…Hypopitiutarism may currently be underestimated in the elderly due to its relatively nonspecific and silent symptoms. 12,13 Furthermore, ageing is associated with a number of endocrine and metabolic changes. 14 The results of endocrine and biochemical tests should be interpreted in different ways for elderly and non-elderly patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical analysis of 103 elderly patients with pituitary adenomas: Transsphenoidal surgery and follow-up

Hong

Ding

2008

Journal of Clinical Neuroscience

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Section: Discussionmentioning

confidence: 99%

Clinical analysis of 103 elderly patients with pituitary adenomas: Transsphenoidal surgery and follow-up

Hong

Ding

2008

Journal of Clinical Neuroscience

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“…In fact, clinical presentation is dominated by visual impairment followed by endocrine symptoms (1 -9). Visual impairment due to chiasmatic compression occurs in 60 -80% of NFPAs (1,3,(5)(6)(7)(8) but fewer than 20% of GH-or ACTH-secreting tumours (2,4,9). Headache is reported in 5-25% of all patients (4 -7) and more frequently in acromegalics (2).…”

Section: Clinical Presentationmentioning

confidence: 99%

“…TSS is generally safe and successful in elderly patients and can be proposed after evaluation of anaesthesiological risk by using the ASA grading (42), excluding patients with ASA 4 or 5 because of excessive surgical risk. Despite an increased anaesthesiological risk in more than 70% of patients due to the presence of mild or severe associated diseases (2,5,7,9), no mortality or major complications were observed in recent series of elderly patients operated on by TSS (2 -5, 7, 9), markedly contrasting with their frequency after craniotomy (6). The incidence of post-operative complications is variably appreciated in this age group, the most frequent being diabetes insipidus (transient in 10 -50%, definitive in less than 10%) and cerebrospinal fluid leak (0 -27%) (2 -5, 7-9), which seems higher than usually reported after TSS (43).…”

Section: Surgerymentioning

confidence: 99%

“…Post-operative visual improvement has been consistently reported in more than 70% of patients (3 -7), despite a small percentage of further visual deterioration due to haemorrhagic or ischaemic damage (1, 4). In contrast, TSS has been rarely associated with improved pituitary function (5,7,9), suggesting that recovery of pre-operative hypopituitarism in the elderly is less frequent than in younger patients (46). Conflicting results have been reported about post-operative regrowth of NFPAs in patients treated by surgery alone (47 -49) and there are very few data in elderly patients (see Table 3).…”

Section: Surgerymentioning

confidence: 99%

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Diagnosis and management of pituitary tumours in the elderly: a review based on personal experience and evidence of literature

Minniti

Esposito

Piccirilli³

et al. 2005

eur j endocrinol

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An increasing proportion of pituitary adenomas are recognized in the elderly, raising the question of their optimal diagnosis and management. Age-related endocrine changes and associated diseases may significantly modify the clinical presentation and hormonal evaluation of these patients. About 80% of pituitary adenomas in this age group are non-secreting, requiring careful differential diagnosis with non-adenomatous sellar lesions. In this group, visual deterioration and hypopituitarism remain the leading symptoms. Recognized secreting tumours are mainly GH-secreting, most of them intrasellar, followed by prolactinomas, which present as clinically non-secreting and are usually invasive. Cushing's disease appears as a very rare eventuality in the elderly. Optimal therapeutic management should aim to control the disease while preserving or improving patient's quality of life. Transsphenoidal surgery has proved to be an efficient and well-tolerated option for non-secreting adenomas with visual defects and intrasellar GH-secreting adenomas, being able to improve metabolic and cardiovascular complications of acromegaly even in this age group. In contrast, dopamine-agonist drugs can be proposed as a primary therapy for prolactinomas even in the presence of severe neurological complications. Because the use of radiotherapy is hampered by its delay of action and potential neurological side effects, its indications should be better defined in this age group. The clinical importance of hypopituitarism should not be underestimated, and thyroid-and adrenal-replacement therapy are mandatory in the presence of documented hormone deficiency, carefully avoiding overtreatment in order to limit possible side effects on the cardiovascular system and bone mineralization. Indications for GH-and sex steroid-replacement therapy still await age-specific guidelines.European Journal of Endocrinology 153 723-735

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“…Visual improvement can be observed in up to 80% of patients (59). Thus, surgery should be indicated for patients with neuro-ophthalmologic complaints and/or tumors affecting the optic pathway.…”

Section: Surgerymentioning

confidence: 99%

A review on the diagnosis and treatment of patients with clinically nonfunctioning pituitary adenoma by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism

Neto

Boguszewski

Araújo

et al. 2016

Arch. Endocrinol. Metab.

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Clinically nonfunctioning pituitary adenomas (NFPA) are the most common pituitary tumors after prolactinomas. The absence of clinical symptoms of hormonal hypersecretion can contribute to the late diagnosis of the disease. Thus, the majority of patients seek medical attention for signs and symptoms resulting from mass effect, such as neuro-ophthalmologic symptoms and hypopituitarism. Other presentations include pituitary apoplexy or an incidental finding on imaging studies. Mass effect and hypopituitarism impose high morbidity and mortality. However, early diagnosis and effective treatment minimizes morbidity and mortality. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism is to provide a review of the diagnosis and treatment of patients with NFPA, emphasizing that the treatment should be performed in reference centers. This review is based on data published in the literature and the authors' experience. Arch Endocrinol Metab. 2016;60(4):374-90

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Surgical Treatment of Clinically Nonsecreting Pituitary Adenomas in Elderly Patients

Cited by 65 publications

References 21 publications

Clinical analysis of 103 elderly patients with pituitary adenomas: Transsphenoidal surgery and follow-up

Clinical analysis of 103 elderly patients with pituitary adenomas: Transsphenoidal surgery and follow-up

Diagnosis and management of pituitary tumours in the elderly: a review based on personal experience and evidence of literature

A review on the diagnosis and treatment of patients with clinically nonfunctioning pituitary adenoma by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism

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