Pituitary surgery in elderly patients with acromegaly

Area of Science:

• Endocrinology
• Neurosurgery
• Geriatric Medicine

Background:

• Elderly patients with acromegaly often face treatment neglect or alternative therapies due to perceived surgical risks.
• An increasing elderly population necessitates evaluating surgical safety and efficacy in this demographic.
• Previous studies have limited data on surgical outcomes for acromegaly in patients over 64 years.

Purpose of the Study:

• To investigate the outcomes of transnasal tumor removal in elderly patients with acromegaly.
• To assess the safety and efficacy of surgical intervention in patients aged 64 years and older.
• To evaluate postoperative complications, hormonal control, and long-term recurrence rates.

Main Methods:

• Retrospective study of 15 patients (13 female, 2 male) with acromegaly, aged over 64 years at the time of surgery.
• Transnasal tumor removal was the primary surgical approach.
• Intraoperative growth hormone (GH) measurements were used to assess radicality of tumor removal.
• Postoperative and long-term follow-up data were collected to evaluate outcomes.

Main Results:

• Transnasal tumor removal was performed without anesthesiological or surgical complications in all patients.
• No postoperative mortality or serious morbidity was observed.
• Postoperative basal GH-plasma levels normalized in all patients (< 4.5 µg/L).
• Long-term follow-up (mean, 4.2 yr) showed no signs of definite tumor recurrence in 13 patients.

Conclusions:

• Transnasal tumor removal is a safe and effective treatment for elderly patients with acromegaly.
• Surgical intervention in this age group leads to excellent hormonal control and low recurrence rates.
• The common belief regarding increased surgical risk in elderly acromegaly patients may be unfounded.