Endocrine Abstracts

The rate of diagnosis of pituitary adenomas in the elderly is increasing, as a consequence of the improved life expectancy. The management of elderly patients affected by pituitary adenomas are still a subject of debate in literature. In particular, data on the safety of endoscopic transnasal transsphenoidal surgery (TNS) are still controversial. The primary endpoint of the present study is to assess the surgical outcome of a cohort of patients who underwent TNS for non-functional pituitary adenoma (NFPA). The secondary endpoint is to evaluate their endocrinological post-TNS outcome and to compare the results with those of a younger control group. Between 2012 and 2019, 353 patients with NFPA underwent TNS-surgery atour Pituitary Centre;among them, only the 188 patients with a complete clinical, hormonal and radiological baseline evaluation and at least one complete post-TNS evaluation were selected. The average follow-up period was 52 months (range 6 – 210). Patients were divided in two groups, depending on their age at surgery (group 1: patients ≥ 70 years-old; group 2: patients < 70 years-old). Data about endocrinological and surgical outcome from the two groups were compared by Pearson’s chi-square test. Forty-three percent of the 188 patients enclosed in the study were ≥ 70 years-old [group 1; mean age 74.3, range 70 – 84], while 57% (n = 107) were <70 years-old [group 2; mean age 50.9, range 21 – 68]. At the first evaluation, visual defects were more common in group 1 (61.7% vs 44.3%; P = 0.03), while headache was predominant in group 2 (36.8% vs 16%; P = 0.002). No significant differences in either pre-TNS surgery pituitary deficits presence or the specific type of hormonal deficits were found between the two groups. Similarly, group 1 and group 2 did not differ in surgical complications rate, the onset of novel post-TNS pituitary deficits, visual field normalization rate, and remission rate. After surgery, a higher recovery rate of pre-existing pituitary deficits was observed in group 2 patients (32.4% vs 6.3%, P = 0.000). In particular, we observed a higher frequency of both gonadal function and GH secretion in group 2 patients (15.8% vs 1.3%, P = 0.001 and 6.34% vs 0%, P = 0.03 respectively). In conclusion, age should not be considered as a predictive factor of surgical complications or worse endocrinological outcome, even if it seems to be associated with a poorer recovery of pre-TNS pituitary deficits.