Exploring endocrinological pitfalls in pituitary surgery in the elderly

Area of Science:

• Neurosurgery
• Endocrinology
• Geriatrics

Background:

• Endoscopic transsphenoidal surgery (ETSS) is increasingly common in elderly individuals.
• Pituitary surgery in the elderly presents unique endocrinological challenges.
• This study specifically investigates these challenges in older patient populations.

Purpose of the Study:

• To compare endocrinological outcomes in early versus late elderly patients undergoing ETSS for non-functioning pituitary adenoma (NFPA).
• To identify potential pitfalls in assessing anterior pituitary function in the elderly post-surgery.

Main Methods:

• Retrospective analysis of 99 elderly patients (≥65 years) with NFPA who underwent ETSS.
• Patients were divided into early (65-74 years) and late (≥75 years) elderly groups.
• Comparison of baseline characteristics and anterior pituitary function, including preoperative and postoperative thyrotropin-releasing hormone (TRH) tests.

Main Results:

• A significant difference in thyroid-stimulating hormone (TSH) response was observed between the early and late elderly groups.
• Preoperative free triiodothyronine (T3) levels correlated with TSH response in early elderly patients.
• In late elderly patients, preoperative free T3 levels were significantly lower, irrespective of TSH response.

Conclusions:

• Early elderly patients with NFPA may have normal TSH secretory capacity if preoperative free T3 levels are normal.
• TSH secretory capacity in late elderly patients requires careful assessment using TRH tests due to altered T3 levels.