Endocrine Abstracts

Introduction and aim: The current population is experiencing an increase in life expectancy, with a consequent change in the demographic structure of the society. It is common, therefore, to find elderly patients with pituitary neuroendocrine tumors (PitNET) in our usual clinical practice. Currently, there are no specific recommendations for treatment and data of outcomes in elderly are scarce. The aim of our study was to compare the clinical characteristics and surgical outcomes of elderly (≥65 years) and younger patients (<65 years) undergoing transphenoidal surgery.

Material and methods: A retrospective study was performed. We included all patients who underwent transphenoidal surgery for PitNET in a tertiary hospital from 2018 to 2023. We stratified the population according to age, considering 65 as the threshold for older age. IBM SPSS26 statistical analysis was used.

Results: 124 patients were included. 32 (26%) of them were ≥ 65 years old. Most elderly patients had non-functioning PitNET while most young patients had functioning PitNET (15.6% vs 62% P<0.001). Besides, most elderly patients had hypopituitarism before surgery (40.6% vs 8.7%, P<0.001). Elderly patients underwent surgery more frequently due to visual compromise while young people due to functionality (31.3% vs 51.1% P=0.012). Larger pituitary tumors were detected in the elderly patients group (20.5 mm vs 18.1 mm, P=0.021). No differences were detected in surgical complications (bleeding, fistula or infection, P=0.752) nor hormonal or electrolyte alterations in the immediate postsurgical period (P=1) between age groups. However, older patients had a longer hospital stay than younger patients (8 days vs 6 days P=0.048). At long-term follow-up (12 months after surgery), no differences were observed between both groups in the rate of biochemical cure of functioning PitNET (60% vs 59.6%, P=0.988) and the rate of normal pituitary hormonal profile (34.4% vs 26.1%, P=0.37). There were differences in the rate of hypopituitarism (50% vs 16.3%, P<0.001) due to the hormonal situation prior to surgery (P<0.001) and not to age differences (P=0.072). In addition, improvement of visual disturbances (31.3% vs 12%, P=0.095) and persistence of remaining adenoma at radiological follow-up (50% vs 44.6%, P=0.830) were similar between older and younger patients.

Conclusions: In our study, older patients with PitNET had a lower prevalence of hormone-secreting tumors, greater prevalence of hypopituitarism, larger tumors and greater visual impairment as an indication for surgery. They had similar surgical outcomes compared to young patients, except for the longer hospital stay.