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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

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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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