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

Our objective was to study the single-center clinical diagnosis and surgical treatment of pituitary adenomas in elderly patients. A retrospective single-center study was performed on 103 patients aged 65 years and over with a diagnosis of pituitary adenoma and with a mean follow-up duration of 6.1+/-1.3 years. All cases were macroadenomas. The clinical course was dominated by visual disturbance and headache, and hypopituitarism was also not uncommon. Despite the majority of patients (81.6%) having coexisting medical conditions, transsphenoidal surgery (TSS) was performed and well tolerated in all patients. Before 2000, conventional post operative radiotherapy was performed in 32 patients with radiological evidence of tumor remnants. Long-term follow-up revealed no tumor regrowth. However, progressive hypopituitarism was found in a number of patients. After 2000, gamma knife surgery was used for selected cases with documented tumor regrowth. All the remnant tumors treated using this approach appeared to either stabilize or regress without side-effects during the study period. The findings of this analysis support the use of TSS as a feasible treatment for pituitary adenomas in elderly patients. Age alone is no longer considered a contra-indication for treatment with TSS. With appropriate perioperative management, the technique is associated with minimal morbidity and is tolerated well by patients regardless of age. Additional follow-up, especially neuroradiological follow-up is needed to monitor tumor recurrence. However, the indications for post operative radiotherapy should be better defined.