Study Shows Transsphenoidal Surgery for Pituitary Adenomas is Safe for Elderly Patients

Elderly female patient

Life expectancy has increased over the past century, causing a shift in the demographic distribution toward older age groups. Elderly patients comprise up to 14% of all patients with pituitary tumors, with most lesions being nonfunctioning pituitary adenomas (NFPAs).

In a recent study published in the Journal of Neurosurgery, neurosurgeon Manish Aghi, MD, PhD, and colleagues analyzed 908 patients undergoing transsphenoidal surgery for NFPA at the UCSF CCPD from 2007 to 2019 and compared the outcomes of 614 patients aged 65 or younger to 294 patients over age 65. Both groups were similar in terms of tumor size and other presenting characteristics. Major outcomes were similar between the groups, including gross total resection rates of over 60% in both groups.

Elderly patients with high morbidities assessed by the Carlson Comorbidity Index had similar outcomes as those with low morbidities. While morbidity rates were very low in both groups, a notable difference in the types of morbidities was that elderly patients were less likely to experience postoperative diabetes insipidus (DI), and more likely to have postoperative hyponatremia, although hyponatremia was always transient and rates of permanent DI were below 4% in both groups. This suggests differences in the electrolyte responses of older versus younger patients to pituitary surgery, an area that is the subject of further study at the CCPD.

An important message of this work is the tremendous safety of pituitary surgery in elderly patients at centers of expertise like the CCPD, and the importance of studies of patient outcomes so that providers and patients can better understand what to expect after pituitary surgery.

Pereira MP, Oh T, Joshi RS, Haddad AF, Pereira KM, Osorio RC, Donohue KC,
Peeran Z, Sudhir S, Jain S, Beniwal A, Gurrola J, El-Sayed IH, Blevins LS,
Theodosopoulos PV, Kunwar S, Aghi MK. Clinical characteristics and outcomes in
elderly patients undergoing transsphenoidal surgery for nonfunctioning pituitary
adenoma. Neurosurg Focus. 2020 Oct;49(4):E19. doi: 10.3171/2020.7.FOCUS20524.
PMID: 33002877.