Endocrinologic Outcomes after Resection of Pituitary Adenomas in Elderly Patients

Background: Patients with a pituitary gland mass, or sellar mass, are likely to have clinical presentations that fall into three categories: visual defects, neurologic symptoms, and hormone. These effects can be related to pathology or mass effect. Identifying preoperative features that correlate with postoperative outcomes following a transsphenoidal surgery can be a useful method to screen patients at high risk for adverse outcomes. This study addresses a high-risk group of elderly patients (age at surgery > or equal to 65 years old) and calculates rates of preoperative deficient hormonal levels and postoperative resolution of those deficiencies.

Methods: A retrospective chart review on patients at or over the age of 65 years old was performed. 66 charts were included from a 4-year time frame. Age, sex, symptom duration, endocrinopathy, history of prior tumor resection, and hormone levels (prolactin, IGF-1, FSH, LH, TSH, T4, ACTH, and AM cortisol) were collected preoperatively. Hormone data were collected from no early than 6 months prior to surgery and no later than 9 months postoperatively. Rates of preoperative and postoperative hormone deficiency, the rate of cases that resolved postoperatively, and the rate of new cases that developed postoperatively were calculated (Table 1).

Results: Mean age of patient was 71.95 years (range: 65–86) and included 42 males (63.6%). Average tumor dimension was 2.35 cm, and 12 (18.2%) patients had a previous resection. Mean duration of symptoms prior to surgery was 41.2 months, with 19 patients (28.8%) presenting with a reported endocrinopathy. Low prolactin levels were present in 7 patients (10.6%), low IGF-1 levels in 14 patients (21.2%), low FSH in 4 patients (6.1%), low LH in 13 patients (19.7%), low TSH in 8 patients (12.1%), low T4 in 5 patients (7.6%), and low ACTH in 2 patients (3%). Postoperative normalization of these low values was seen in 57.1% of prolactin cases, 78.6% of IGF-1 cases, 75% of FSH cases, 69.2% of LH cases, 62.5% of TSH cases, 80% of T4 cases and 100% of low preoperative ACTH cases. By 18 months postoperatively, 93.7% of low AM cortisol had normalized. New postoperative cases of hormonal deficiencies were noted in each hormonal category, excluding AM cortisol in addition to the cases of postoperative hormonal deficiencies that did not resolve. New cases included 1 patient with low prolactin (25%), 12 new patients with low IGF-1 (80%), 3 new patients with low FSH (50%), 4 new patients with low LH (50%), 3 new patients with low TSH (50%), 4 new patients with low T4 (80%), and 2 new patients with low ACTH (100%).

Conclusion: This study characterized the rates of endocrinological recovery and rates of postoperative endocrine deficit in elderly patients. Compared with our experience in a cohort including younger patients, elderly patients present less frequently with endocrinopathy. This study identified both preoperative and postoperative frequencies of hormonal deficiencies in addition to calculating rates of postoperative resolution and postoperative development of new cases. Follow-up studies will need to elucidate risk factors that precipitate the new cases and the mediating factors that predict postoperative endocrine normalization.