title: Comparison of Pituitary Adenomas in Elderly and Younger Adults: Clinical Characteristics, Surgical Outcomes, and Prognosis.
abstract: OBJECTIVE
  To analyze and summarize the clinical characteristics, surgical outcomes, and prognosis of elderly adults with pituitary adenomas (PAs).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tongji Hospital.
  
  
  METHODS
  Individuals who underwent transsphenoidal surgery for PAs between 2009 and 2012 (N = 1,104).
  
  
  METHODS
  Participants were divided into two age groups (≥65 and <65), and their clinical characteristics, surgical complications, surgical outcomes, and follow-up data were analyzed and compared.
  
  
  RESULTS
  The older group had longer duration of symptoms. The most common symptom were mass effects (98.4%) in the older group and hormone-secreting effects (55.2%) in the younger group. The incidence of pituitary apoplexy (P = .03), incidentaloma (P = .03) and misdiagnosis at first visit (P < .001) were higher in the older group. Nonfunctioning PAs (P < .001) and giant adenomas (P = .04) were more common in the elderly group than in the younger group. There were no significant differences in the incidence of postoperative diabetes insipidus, cerebrospinal fluid (CSF) leak, regrowth, visual outcome, or permanent hypopituitarism between the groups (P > .05). The incidence of severe systemic complications was greater in the older group (3/69 vs 3/1,035, relative risk = 15.00, 95% confidence interval = 3.08-72.94, P = .004), and all three cases in the older group occurred after emergency surgery. The incidence of hypopituitarism before surgery and 3 days after surgery was higher in the elderly group (P < .05). Older participants tended to have more difficulty recovering from preoperative hypopituitarism (P = .02).
  
  
  CONCLUSIONS
  Avoiding misdiagnosis and emergency surgery is critical for frail elderly adults with multiple comorbidities. With early active management, sufficient preoperative preparation, and multidisciplinary collaboration, the long-term outcomes and prognosis of elderly adults with PAs are comparable with those of younger adults.
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Junfeng
authors: J
authors: Liu
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Chaoxi
authors: C
authors: Li
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Qungen
authors: Q
authors: Xiao
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Chao
authors: C
authors: Gan
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Xi
authors: X
authors: Chen
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Wei
authors: W
authors: Sun
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Xiaopeng
authors: X
authors: Li
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Yu
authors: Y
authors: Xu
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Juan
authors: J
authors: Chen
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Kai
authors: K
authors: Shu
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Ting
authors: T
authors: Lei
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
keywords: comparative study; elderly; pituitary adenoma; transsphenoidal surgery