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Pituitary Adenomas

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Brain and Spine Surgery in the Elderly

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Abstract

Because of the increasing life expectancy and improving of diagnostic methods, management of pituitary adenomas in elderly patients is growing with time and, actually, the incidence rate has reached value of 7–10 %; more than 80 % of these lesions result in non-functioning pituitary adenomas.

Visual field defects and hypopituitarism, both related to mass effect, remain the leading symptoms, although these masses can be completely asymptomatic (pituitary incidentalomas) or eventually disclosed upon occurrence of apoplexy (10 %). Nevertheless, because ageing is related to several endocrinological and metabolic changes, including significant modification of the hypothalamo-hypophyseal functions, clinical features of the eventual pituitary disorder may be misdiagnosed.

The rates of prevalence for macroadenomas in elderly are higher as compared to the other age groups, but these tumours do not present inner increased invasiveness, probably due to the lower cell proliferation rate identified. The surgical management of pituitary adenomas in the elderly is somehow burdened by the presence of mild and/or severe systemic co-morbidities (specially cardiovascular, respiratory and neurological disorders) found in more than 50 % of patients; this aspect dramatically increases anaesthesiological risk and significantly the mortality rate between young and elderly patients.

Endoscopic endonasal approach is usually safe and successful in this group of patients, and the ophthalmological and endocrinological outcomes are satisfactory as those of the younger group, also at a long follow-up.

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Abbreviations

ACTH:

Adrenocorticotropin

ASA:

American Society of Anesthesiologists

AVP:

Arginine vasopressin

CAD:

Coronary artery disease

CSF:

Cerebrospinal fluid

DI:

Diabetes insipidus

FSH:

Follicle-stimulating hormone

GH:

Growth hormone

GTR:

Gross total removal

IHD:

Ischemic heart disease

LH:

Luteinizing hormone

NFPA:

Non-functioning pituitary adenoma

PA:

Pituitary adenoma

PRL:

Prolactin

SIADH:

Syndrome of inappropriate antidiuretic hormone

STR:

Subtotal removal

TSH:

Thyroid-stimulating hormone

VDF:

Visual field deficit

References

  1. Asa SL, Ezzat S (2002) The pathogenesis of pituitary tumours. Nat Rev Cancer 2(11):836–849. doi:10.1038/nrc926

    Article  CAS  PubMed  Google Scholar 

  2. Benbow SJ, Foy P, Jones B, Shaw D, MacFarlane IA (1997) Pituitary tumours presenting in the elderly: management and outcome. Clin Endocrinol (Oxf) 46(6):657–660

    Article  CAS  Google Scholar 

  3. Cappabianca P, Cavallo LM, Colao A, Del Basso De Caro M, Esposito F, Cirillo S, Lombardi G, de Divitiis E (2002) Endoscopic endonasal transsphenoidal approach: outcome analysis of 100 consecutive procedures. Minim Invasive Neurosurg MIN 45(4):193–200. doi:10.1055/s-2002-36197

    Article  CAS  PubMed  Google Scholar 

  4. Cappabianca P, Cavallo LM, Solari D, Stagno V, Esposito F, de Angelis M (2014) Endoscopic endonasal surgery for pituitary adenomas. World Neurosurg 82(6 Suppl):S3–S11. doi:10.1016/j.wneu.2014.07.019

    Article  PubMed  Google Scholar 

  5. Chang EF, Zada G, Kim S, Lamborn KR, Quinones-Hinojosa A, Tyrrell JB, Wilson CB, Kunwar S (2008) Long-term recurrence and mortality after surgery and adjuvant radiotherapy for nonfunctional pituitary adenomas. J Neurosurg 108(4):736–745. doi:10.3171/JNS/2008/108/4/0736

    Article  PubMed  Google Scholar 

  6. Christensen K, Doblhammer G, Rau R, Vaupel JW (2009) Ageing populations: the challenges ahead. Lancet 374(9696):1196–1208. doi:10.1016/S0140-6736(09)61460-4

    Article  PubMed  PubMed Central  Google Scholar 

  7. Del Monte P, Foppiani L, Ruelle A, Andrioli G, Bandelloni R, Quilici P, Prete C, Palummeri E, Marugo A, Bernasconi D (2007) Clinically non-functioning pituitary macroadenomas in the elderly. Aging Clin Exp Res 19(1):34–40

    Article  PubMed  Google Scholar 

  8. Di Maio S, Cavallo LM, Esposito F, Stagno V, Corriero OV, Cappabianca P (2011) Extended endoscopic endonasal approach for selected pituitary adenomas: early experience. J Neurosurg 114(2):345–353. doi:10.3171/2010.9.JNS10262

    Article  PubMed  Google Scholar 

  9. Dumont AS, Nemergut EC 2nd, Jane JA Jr, Laws ER Jr (2005) Postoperative care following pituitary surgery. J Intensive Care Med 20(3):127–140. doi:10.1177/0885066605275247

    Article  PubMed  Google Scholar 

  10. Duntze J, Litre CF, Graillon T, Maduri R, Pech-gourg G, Rakotozanany P, Gras R, Dufour H (2012) Cerebrospinal fluid rhinorrhea following endocopic trans-sphenoidal pituitary surgery: experience from 337 patients. Neurochirurgie 58(4):241–245. doi:10.1016/j.neuchi.2012.02.005

    Article  CAS  PubMed  Google Scholar 

  11. Ferrante L, Trillo G, Ramundo E, Celli P, Jaffrain-Rea ML, Salvati M, Esposito V, Roperto R, Osti MF, Minniti G (2002) Surgical treatment of pituitary tumors in the elderly: clinical outcome and long-term follow-up. J Neurooncol 60(2):185–191

    Article  PubMed  Google Scholar 

  12. Gondim JA, Almeida JP, de Albuquerque LA, Gomes E, Schops M, Mota JI (2015) Endoscopic endonasal transsphenoidal surgery in elderly patients with pituitary adenomas. J Neurosurg 123(1):31–38. doi:10.3171/2014.10.JNS14372

    Article  PubMed  Google Scholar 

  13. Grossman R, Mukherjee D, Chaichana KL, Salvatori R, Wand G, Brem H, Chang DC, Quinones-Hinojosa A (2010) Complications and death among elderly patients undergoing pituitary tumour surgery. Clin Endocrinol (Oxf) 73(3):361–368. doi:10.1111/j.1365-2265.2010.03813.x

    Article  Google Scholar 

  14. Hong J, Ding X, Lu Y (2008) Clinical analysis of 103 elderly patients with pituitary adenomas: transsphenoidal surgery and follow-up. J Clin Neurosci Off J Neurosurg Soc Australasia 15(10):1091–1095. doi:10.1016/j.jocn.2007.11.003

    Google Scholar 

  15. Jaffrain-Rea ML, Di Stefano D, Minniti G, Esposito V, Bultrini A, Ferretti E, Santoro A, Faticanti Scucchi L, Gulino A, Cantore G (2002) A critical reappraisal of MIB-1 labelling index significance in a large series of pituitary tumours: secreting versus non-secreting adenomas. Endocr Relat Cancer 9(2):103–113

    Article  CAS  PubMed  Google Scholar 

  16. Kuchel GA, Minaker KL (1990) Dizziness in geriatric practice. J Am Geriatr Soc 38(8):957

    Article  CAS  PubMed  Google Scholar 

  17. Kurosaki M, Saeger W, Ludecke DK (2001) Pituitary tumors in the elderly. Pathol Res Pract 197(7):493–497. doi:10.1078/0344-0338-00117

    Article  CAS  PubMed  Google Scholar 

  18. Lamberts SW, van den Beld AW, van der Lely AJ (1997) The endocrinology of aging. Science 278(5337):419–424

    Article  CAS  PubMed  Google Scholar 

  19. Letournel F, Menei P, Guy G, Saint-Andre JP (2003) Transsphenoidal surgery in the elderly. J Am Geriatr Soc 51(5):729–730

    Article  PubMed  Google Scholar 

  20. Liu J, Li C, Xiao Q, Gan C, Chen X, Sun W, Li X, Xu Y, Chen J, Shu K, Lei T (2015) Comparison of pituitary adenomas in elderly and younger adults: clinical characteristics, surgical outcomes, and prognosis. J Am Geriatr Soc 63(9):1924–1930. doi:10.1111/jgs.13590

    Article  PubMed  Google Scholar 

  21. Locatelli M, Bertani G, Carrabba G, Rampini P, Zavanone M, Caroli M, Sala E, Ferrante E, Gaini SM, Spada A, Mantovani G, Lania A (2013) The trans-sphenoidal resection of pituitary adenomas in elderly patients and surgical risk. Pituitary 16(2):146–151. doi:10.1007/s11102-012-0390-z

    Article  CAS  PubMed  Google Scholar 

  22. Minniti G, Esposito V, Piccirilli M, Fratticci A, Santoro A, Jaffrain-Rea ML (2005) Diagnosis and management of pituitary tumours in the elderly: a review based on personal experience and evidence of literature. Eur J Endocrinol/Eur Fed Endocrine Soc 153(6):723–735. doi:10.1530/eje.1.02030

    Article  CAS  Google Scholar 

  23. Ogra S, Nichols AD, Stylli S, Kaye AH, Savino PJ, Danesh-Meyer HV (2014) Visual acuity and pattern of visual field loss at presentation in pituitary adenoma. J Clin Neurosci Off J Neurosurg Soc Australasia 21(5):735–740. doi:10.1016/j.jocn.2014.01.005

    Google Scholar 

  24. Robenshtok E, Benbassat CA, Hirsch D, Tzvetov G, Cohen ZR, Iraqi HM, Gorshtein A, Toledano Y, Shimon I (2014) Clinical course and outcome of nonfunctioning pituitary adenomas in the elderly compared with younger age groups. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinologists 20(2):159–164. doi:10.4158/EP13182.OR

    Google Scholar 

  25. Schreckinger M, Szerlip N, Mittal S (2013) Diabetes insipidus following resection of pituitary tumors. Clin Neurol Neurosurg 115(2):121–126. doi:10.1016/j.clineuro.2012.08.009

    Article  PubMed  Google Scholar 

  26. Sheehan JM, Douds GL, Hill K, Farace E (2008) Transsphenoidal surgery for pituitary adenoma in elderly patients. Acta Neurochir 150(6):571–574. doi:10.1007/s00701-008-1581-2; discussion 574

    Article  CAS  PubMed  Google Scholar 

  27. Shiley SG, Limonadi F, Delashaw JB, Barnwell SL, Andersen PE, Hwang PH, Wax MK (2003) Incidence, etiology, and management of cerebrospinal fluid leaks following trans-sphenoidal surgery. Laryngoscope 113(8):1283–1288. doi:10.1097/00005537-200308000-00003

    Article  PubMed  Google Scholar 

  28. Solari D, Cavallo LM, Cappabianca P (2014) Surgical approach to pituitary tumors. Handb Clin Neurol 124:291–301. doi:10.1016/B978-0-444-59602-4.00019-8

    Article  PubMed  Google Scholar 

  29. Solari D, Cavallo LM, De Angelis M, Villa A, Somma T, Esposito F, Del Basso De Caro M, Cappabianca P (2012) Advances in trans-sphenoidal pituitary surgery. Panminerva Med 54(4):271–276

    CAS  PubMed  Google Scholar 

  30. Tanaka Y, Hongo K, Tada T, Sakai K, Kakizawa Y, Kobayashi S (2003) Growth pattern and rate in residual nonfunctioning pituitary adenomas: correlations among tumor volume doubling time, patient age, and MIB-1 index. J Neurosurg 98(2):359–365. doi:10.3171/jns.2003.98.2.0359

    Article  PubMed  Google Scholar 

  31. Turner HE, Adams CB, Wass JA (1999) Pituitary tumours in the elderly: a 20 year experience. Eur J Endocrinol/Eur Fed Endocrine Soc 140(5):383–389

    Article  CAS  Google Scholar 

  32. Zhan R, Ma Z, Wang D, Li X (2015) Pure endoscopic endonasal transsphenoidal approach for nonfunctioning pituitary adenomas in the elderly: surgical outcomes and complications in 158 patients. World Neurosurg 84(6):1572–1578. doi:10.1016/j.wneu.2015.08.035

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Via Pansini 5, 80131, Naples, Italy

    Paolo Cappabianca MD, Chiara Caggiano MD, Domenico Solari MD, PhD, Karol Migliorati MD & Luigi M. Cavallo MD, PhD

  2. Department of Neurosurgery, Ibn Sina Hospital, Kuwait city, Kuwait

    Waleed A. Azab MD

  3. Department of Advanced Biomedical Sciences, Università degli Studi di Napoli Federico II, Naples, Italy

    Elia Guadagno MD & Marialaura Del Basso De Caro BS

  4. Department of Neurosurgery, University Hospital of Lyon – Hospices Civils de Lyon, Lyon, France

    Emmanuel Jouanneau MD, PhD

Authors
  1. Paolo Cappabianca MD
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  2. Chiara Caggiano MD
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  3. Domenico Solari MD, PhD
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  4. Karol Migliorati MD
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  5. Waleed A. Azab MD
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  6. Elia Guadagno MD
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  7. Marialaura Del Basso De Caro BS
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  8. Emmanuel Jouanneau MD, PhD
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  9. Luigi M. Cavallo MD, PhD
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Corresponding author

Correspondence to Paolo Cappabianca MD .

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Editors and Affiliations

  1. Department of Neurosurgery, University Hospital of Lyon, Lyon, France

    Moncef Berhouma

  2. Hôpital des Charpennes, Hospices civils de Lyon, Villeurbanne, France

    Pierre Krolak-Salmon

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Cappabianca, P. et al. (2017). Pituitary Adenomas. In: Berhouma, M., Krolak-Salmon, P. (eds) Brain and Spine Surgery in the Elderly. Springer, Cham. https://doi.org/10.1007/978-3-319-40232-1_9

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  • DOI: https://doi.org/10.1007/978-3-319-40232-1_9

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