Transsphenoidal Surgery for Pituitary Neuroendocrine Tumours (PiTNETs) in a Tertiary Hospital: Are There Differences Between Young and Elderly Patients?

Abstract

Objective: The incidence of pituitary neuroendocrine tumours (PiTNET) in elderly patients is rising, but treatment recommendations and data of outcomes are limited. This study aimed to compare the clinical characteristics and surgical outcomes of elderly and younger patients.

Design: Retrospective and observational study.

Patients: One hundred twenty-four adults underwent transsphenoidal surgery due to PiTNET in our hospital from 2018 to 2023.

Measurements: We stratified the population according to age and compared the clinical features and surgical outcomes.

Results: Thirty-two patients (25.8%) were 65 years or older. Elderly patients had a lower rate of hormonal excess (15.6% vs. 60.9%, p < 0.001) and a higher rate of hypopituitarism (43.8% vs. 8.7%, p < 0.001), with a greater median number of affected axis (3 vs. 1, p < 0.001). Only the rate of ACTH excess was different between groups (0 vs. 26.1%, p = 0.003). The most common surgical indication in elderly patients was visual impairment (31.3%) compared to functionality in younger individuals (42.4%, p = 0.012). There were no differences in the Knosp grade, but elderly patients had a higher rate of macroadenomas (84.4% vs. 58.7%, p = 0.002). In the immediate postsurgical period, there were no differences in the rate of surgical or hormonal complications, or in the hospital stay. Ki67 was lower in elderly patients (1.44% vs. 2.77%, p = 0.045). After 6-12 months, there were no differences in the tumour resection rate, visual improvement, or hormonal status.

Conclusion: With experienced surgical and endocrinological care, transsphenoidal surgery for elderly patients with PiTNET is effective and safe.