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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
Chapter

Abstract

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.

Keywords

Pituitary adenomas Elderly Endoscopic endonasal transsphenoidal approach 

Abbreviations

ACTH

Adrenocorticotropin

ASA

American Society of Anesthesiologists

AVP

Arginine vasopressin

CAD

Coronary artery disease

CSF

Cerebrospinal fluid

DI

Diabetes insipidus

FSH

Follicle-stimulating hormone

GH

Growth hormone

GTR

Gross total removal

IHD

Ischemic heart disease

LH

Luteinizing hormone

NFPA

Non-functioning pituitary adenoma

PA

Pituitary adenoma

PRL

Prolactin

SIADH

Syndrome of inappropriate antidiuretic hormone

STR

Subtotal removal

TSH

Thyroid-stimulating hormone

VDF

Visual field deficit

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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

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