Pituitary Adenomas

  • Paolo CappabiancaEmail author
  • Chiara Caggiano
  • Domenico Solari
  • Karol Migliorati
  • Waleed A. Azab
  • Elia Guadagno
  • Marialaura Del Basso De Caro
  • Emmanuel Jouanneau
  • Luigi M. Cavallo


Because of the increasing life expectancy and improving of diagnostic methods, management of pituitary adenomas in elderly patients is growing with time and, actually, the incidence rate has reached value of 7–10 %; more than 80 % of these lesions result in non-functioning pituitary adenomas.

Visual field defects and hypopituitarism, both related to mass effect, remain the leading symptoms, although these masses can be completely asymptomatic (pituitary incidentalomas) or eventually disclosed upon occurrence of apoplexy (10 %). Nevertheless, because ageing is related to several endocrinological and metabolic changes, including significant modification of the hypothalamo-hypophyseal functions, clinical features of the eventual pituitary disorder may be misdiagnosed.

The rates of prevalence for macroadenomas in elderly are higher as compared to the other age groups, but these tumours do not present inner increased invasiveness, probably due to the lower cell proliferation rate identified. The surgical management of pituitary adenomas in the elderly is somehow burdened by the presence of mild and/or severe systemic co-morbidities (specially cardiovascular, respiratory and neurological disorders) found in more than 50 % of patients; this aspect dramatically increases anaesthesiological risk and significantly the mortality rate between young and elderly patients.

Endoscopic endonasal approach is usually safe and successful in this group of patients, and the ophthalmological and endocrinological outcomes are satisfactory as those of the younger group, also at a long follow-up.


Pituitary adenomas Elderly Endoscopic endonasal transsphenoidal approach 





American Society of Anesthesiologists


Arginine vasopressin


Coronary artery disease


Cerebrospinal fluid


Diabetes insipidus


Follicle-stimulating hormone


Growth hormone


Gross total removal


Ischemic heart disease


Luteinizing hormone


Non-functioning pituitary adenoma


Pituitary adenoma




Syndrome of inappropriate antidiuretic hormone


Subtotal removal


Thyroid-stimulating hormone


Visual field deficit


  1. 1.
    Asa SL, Ezzat S (2002) The pathogenesis of pituitary tumours. Nat Rev Cancer 2(11):836–849. doi: 10.1038/nrc926 CrossRefPubMedGoogle Scholar
  2. 2.
    Benbow SJ, Foy P, Jones B, Shaw D, MacFarlane IA (1997) Pituitary tumours presenting in the elderly: management and outcome. Clin Endocrinol (Oxf) 46(6):657–660CrossRefGoogle Scholar
  3. 3.
    Cappabianca P, Cavallo LM, Colao A, Del Basso De Caro M, Esposito F, Cirillo S, Lombardi G, de Divitiis E (2002) Endoscopic endonasal transsphenoidal approach: outcome analysis of 100 consecutive procedures. Minim Invasive Neurosurg MIN 45(4):193–200. doi: 10.1055/s-2002-36197 CrossRefPubMedGoogle Scholar
  4. 4.
    Cappabianca P, Cavallo LM, Solari D, Stagno V, Esposito F, de Angelis M (2014) Endoscopic endonasal surgery for pituitary adenomas. World Neurosurg 82(6 Suppl):S3–S11. doi: 10.1016/j.wneu.2014.07.019 CrossRefPubMedGoogle Scholar
  5. 5.
    Chang EF, Zada G, Kim S, Lamborn KR, Quinones-Hinojosa A, Tyrrell JB, Wilson CB, Kunwar S (2008) Long-term recurrence and mortality after surgery and adjuvant radiotherapy for nonfunctional pituitary adenomas. J Neurosurg 108(4):736–745. doi: 10.3171/JNS/2008/108/4/0736 CrossRefPubMedGoogle Scholar
  6. 6.
    Christensen K, Doblhammer G, Rau R, Vaupel JW (2009) Ageing populations: the challenges ahead. Lancet 374(9696):1196–1208. doi: 10.1016/S0140-6736(09)61460-4 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Del Monte P, Foppiani L, Ruelle A, Andrioli G, Bandelloni R, Quilici P, Prete C, Palummeri E, Marugo A, Bernasconi D (2007) Clinically non-functioning pituitary macroadenomas in the elderly. Aging Clin Exp Res 19(1):34–40CrossRefPubMedGoogle Scholar
  8. 8.
    Di Maio S, Cavallo LM, Esposito F, Stagno V, Corriero OV, Cappabianca P (2011) Extended endoscopic endonasal approach for selected pituitary adenomas: early experience. J Neurosurg 114(2):345–353. doi: 10.3171/2010.9.JNS10262 CrossRefPubMedGoogle Scholar
  9. 9.
    Dumont AS, Nemergut EC 2nd, Jane JA Jr, Laws ER Jr (2005) Postoperative care following pituitary surgery. J Intensive Care Med 20(3):127–140. doi: 10.1177/0885066605275247 CrossRefPubMedGoogle Scholar
  10. 10.
    Duntze J, Litre CF, Graillon T, Maduri R, Pech-gourg G, Rakotozanany P, Gras R, Dufour H (2012) Cerebrospinal fluid rhinorrhea following endocopic trans-sphenoidal pituitary surgery: experience from 337 patients. Neurochirurgie 58(4):241–245. doi: 10.1016/j.neuchi.2012.02.005 CrossRefPubMedGoogle Scholar
  11. 11.
    Ferrante L, Trillo G, Ramundo E, Celli P, Jaffrain-Rea ML, Salvati M, Esposito V, Roperto R, Osti MF, Minniti G (2002) Surgical treatment of pituitary tumors in the elderly: clinical outcome and long-term follow-up. J Neurooncol 60(2):185–191CrossRefPubMedGoogle Scholar
  12. 12.
    Gondim JA, Almeida JP, de Albuquerque LA, Gomes E, Schops M, Mota JI (2015) Endoscopic endonasal transsphenoidal surgery in elderly patients with pituitary adenomas. J Neurosurg 123(1):31–38. doi: 10.3171/2014.10.JNS14372 CrossRefPubMedGoogle Scholar
  13. 13.
    Grossman R, Mukherjee D, Chaichana KL, Salvatori R, Wand G, Brem H, Chang DC, Quinones-Hinojosa A (2010) Complications and death among elderly patients undergoing pituitary tumour surgery. Clin Endocrinol (Oxf) 73(3):361–368. doi: 10.1111/j.1365-2265.2010.03813.x CrossRefGoogle Scholar
  14. 14.
    Hong J, Ding X, Lu Y (2008) Clinical analysis of 103 elderly patients with pituitary adenomas: transsphenoidal surgery and follow-up. J Clin Neurosci Off J Neurosurg Soc Australasia 15(10):1091–1095. doi: 10.1016/j.jocn.2007.11.003 Google Scholar
  15. 15.
    Jaffrain-Rea ML, Di Stefano D, Minniti G, Esposito V, Bultrini A, Ferretti E, Santoro A, Faticanti Scucchi L, Gulino A, Cantore G (2002) A critical reappraisal of MIB-1 labelling index significance in a large series of pituitary tumours: secreting versus non-secreting adenomas. Endocr Relat Cancer 9(2):103–113CrossRefPubMedGoogle Scholar
  16. 16.
    Kuchel GA, Minaker KL (1990) Dizziness in geriatric practice. J Am Geriatr Soc 38(8):957CrossRefPubMedGoogle Scholar
  17. 17.
    Kurosaki M, Saeger W, Ludecke DK (2001) Pituitary tumors in the elderly. Pathol Res Pract 197(7):493–497. doi: 10.1078/0344-0338-00117 CrossRefPubMedGoogle Scholar
  18. 18.
    Lamberts SW, van den Beld AW, van der Lely AJ (1997) The endocrinology of aging. Science 278(5337):419–424CrossRefPubMedGoogle Scholar
  19. 19.
    Letournel F, Menei P, Guy G, Saint-Andre JP (2003) Transsphenoidal surgery in the elderly. J Am Geriatr Soc 51(5):729–730CrossRefPubMedGoogle Scholar
  20. 20.
    Liu J, Li C, Xiao Q, Gan C, Chen X, Sun W, Li X, Xu Y, Chen J, Shu K, Lei T (2015) Comparison of pituitary adenomas in elderly and younger adults: clinical characteristics, surgical outcomes, and prognosis. J Am Geriatr Soc 63(9):1924–1930. doi: 10.1111/jgs.13590 CrossRefPubMedGoogle Scholar
  21. 21.
    Locatelli M, Bertani G, Carrabba G, Rampini P, Zavanone M, Caroli M, Sala E, Ferrante E, Gaini SM, Spada A, Mantovani G, Lania A (2013) The trans-sphenoidal resection of pituitary adenomas in elderly patients and surgical risk. Pituitary 16(2):146–151. doi: 10.1007/s11102-012-0390-z CrossRefPubMedGoogle Scholar
  22. 22.
    Minniti G, Esposito V, Piccirilli M, Fratticci A, Santoro A, Jaffrain-Rea ML (2005) Diagnosis and management of pituitary tumours in the elderly: a review based on personal experience and evidence of literature. Eur J Endocrinol/Eur Fed Endocrine Soc 153(6):723–735. doi: 10.1530/eje.1.02030 CrossRefGoogle Scholar
  23. 23.
    Ogra S, Nichols AD, Stylli S, Kaye AH, Savino PJ, Danesh-Meyer HV (2014) Visual acuity and pattern of visual field loss at presentation in pituitary adenoma. J Clin Neurosci Off J Neurosurg Soc Australasia 21(5):735–740. doi: 10.1016/j.jocn.2014.01.005 Google Scholar
  24. 24.
    Robenshtok E, Benbassat CA, Hirsch D, Tzvetov G, Cohen ZR, Iraqi HM, Gorshtein A, Toledano Y, Shimon I (2014) Clinical course and outcome of nonfunctioning pituitary adenomas in the elderly compared with younger age groups. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinologists 20(2):159–164. doi: 10.4158/EP13182.OR Google Scholar
  25. 25.
    Schreckinger M, Szerlip N, Mittal S (2013) Diabetes insipidus following resection of pituitary tumors. Clin Neurol Neurosurg 115(2):121–126. doi: 10.1016/j.clineuro.2012.08.009 CrossRefPubMedGoogle Scholar
  26. 26.
    Sheehan JM, Douds GL, Hill K, Farace E (2008) Transsphenoidal surgery for pituitary adenoma in elderly patients. Acta Neurochir 150(6):571–574. doi: 10.1007/s00701-008-1581-2; discussion 574CrossRefPubMedGoogle Scholar
  27. 27.
    Shiley SG, Limonadi F, Delashaw JB, Barnwell SL, Andersen PE, Hwang PH, Wax MK (2003) Incidence, etiology, and management of cerebrospinal fluid leaks following trans-sphenoidal surgery. Laryngoscope 113(8):1283–1288. doi: 10.1097/00005537-200308000-00003 CrossRefPubMedGoogle Scholar
  28. 28.
    Solari D, Cavallo LM, Cappabianca P (2014) Surgical approach to pituitary tumors. Handb Clin Neurol 124:291–301. doi: 10.1016/B978-0-444-59602-4.00019-8 CrossRefPubMedGoogle Scholar
  29. 29.
    Solari D, Cavallo LM, De Angelis M, Villa A, Somma T, Esposito F, Del Basso De Caro M, Cappabianca P (2012) Advances in trans-sphenoidal pituitary surgery. Panminerva Med 54(4):271–276PubMedGoogle Scholar
  30. 30.
    Tanaka Y, Hongo K, Tada T, Sakai K, Kakizawa Y, Kobayashi S (2003) Growth pattern and rate in residual nonfunctioning pituitary adenomas: correlations among tumor volume doubling time, patient age, and MIB-1 index. J Neurosurg 98(2):359–365. doi: 10.3171/jns.2003.98.2.0359 CrossRefPubMedGoogle Scholar
  31. 31.
    Turner HE, Adams CB, Wass JA (1999) Pituitary tumours in the elderly: a 20 year experience. Eur J Endocrinol/Eur Fed Endocrine Soc 140(5):383–389CrossRefGoogle Scholar
  32. 32.
    Zhan R, Ma Z, Wang D, Li X (2015) Pure endoscopic endonasal transsphenoidal approach for nonfunctioning pituitary adenomas in the elderly: surgical outcomes and complications in 158 patients. World Neurosurg 84(6):1572–1578. doi: 10.1016/j.wneu.2015.08.035 CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Paolo Cappabianca
    • 1
    Email author
  • Chiara Caggiano
    • 1
  • Domenico Solari
    • 1
  • Karol Migliorati
    • 1
  • Waleed A. Azab
    • 2
  • Elia Guadagno
    • 3
  • Marialaura Del Basso De Caro
    • 3
  • Emmanuel Jouanneau
    • 4
  • Luigi M. Cavallo
    • 1
  1. 1.Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological SciencesUniversità degli Studi di Napoli Federico IINaplesItaly
  2. 2.Department of NeurosurgeryIbn Sina HospitalKuwait cityKuwait
  3. 3.Department of Advanced Biomedical SciencesUniversità degli Studi di Napoli Federico IINaplesItaly
  4. 4.Department of NeurosurgeryUniversity Hospital of Lyon – Hospices Civils de LyonLyonFrance

Personalised recommendations