Abstract
Given advances and wide availability of neuroimaging coupled with longer life span, higher numbers of elderly patients with pituitary adenomas are being seen who are potential surgical or medical therapy candidates. Our study concerns 07 cases of Pituitary adenoma in patients aged more than 70 years old, collected in Mustapha Pasha’s neurosurgery department in Algiers for a period of 18 years (from 2000 to 2018). Pituitary adenoma is not considered a disease of advanced age; its incidence is rated around 3–4%. The average age of patients was 72 years old, slightly more common in females and represents 60% of the cases. The average duration of symptoms before diagnosis is 2 and half years. The clinical signs were dominated by visual deterioration, and in a lesser degree a hypopituitarism. Neuro-imaging (CT scan/ MRI) are the key exams. MRI is important especially in the development of surgical planning. Collected radiological data reported the presence of macro adenoma with supra sellar extension in the majority of our cases; The surgical approach was transnasal- Transsphenoidal in all patients. The evolution was satisfactory for the majority of patients. However, complications were noted. We deplore the death of a patient presented with meningitis. Patients over age 70 with pituitary tumors and indications for surgery should be considered surgical candidates for transsphenoidalsurgery given the low risks of this procedure.
Highlights
Pituitary adenomas (PAs) are common benign intra-cranial neoplasms, with an estimated prevalence of 16.7% in the general population. [3,4]
While several studies have shown the relative safety of transsphenoidal surgery for elderly patients with symptomatic pituitary adenomas, the complication rates reported in the literature with progressive age remain significant and cautionary [10,11,12]
Tumor size and extension were evaluated with the Hardy classification: One case was considered an intrasellar adenoma, 05 cases an enclosed adenoma with little suprasellar extension
Summary
Pituitary adenomas (PAs) are common benign intra-cranial neoplasms, with an estimated prevalence of 16.7% in the general population. [3,4]. Non functioning PAs (NFPAs) are a type of PA without clinical evidence of excess hormone secretion, and, due to their silent nature, patients present with symptoms related to mass effect, such as visual disturbances. While several studies have shown the relative safety of transsphenoidal surgery for elderly patients with symptomatic pituitary adenomas, the complication rates reported in the literature with progressive age remain significant and cautionary [10,11,12]. According to the latest guidelines, TNS is recommended in elderly patients with NFPAs associated with visual disturbances [13,14], whereas the indication for surgery in individuals without evidence of visual impairment is still a matter of debate, given the slow growth of PAs and the increase in age-related anesthetic and surgical risk ]13,15,16,17]
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