Clinical features and follow-up study of 49 elderly patients with pituitary adenomas / 中华老年医学杂志

ABSTRACT

Objective To study the clinical features and therapeutic effects of pituitary adenomas in elderly patients. Methods The clinical materials including main clinical manifestations, diagnostic methods and outcome of treatments of 49 elderly patients with the pituitary adenomas from 1987 to1998 were analyzed retrospectively. Results It was showed from the data that the average duration of illness was 4 4 years; and 46(93 8%) cases were with visual deterioration, 20 (40 8%) with headache, and 16(32 7%) with endocrine abnormality. The diameter of tumors was more than 3 cm in 25 (51 0%), and the non functioning adenomas were found in 27 (55 1%). Operation was undergone through trans sphenoidal (61 2%), subfrontal (32 7%) and extensive subfrontal extradural approaches(6 1%), respectively. Among the 49 cases, tumor was totally or subtotally removed in 38 cases (77 6%), large partially or partially removed in 11 cases (22 4%). The results of operation through the trans sphenoidal approach were superior to other routes All patients were long term followed up for an average of 50 5 months. Visual disturbances were improved in 27 of 46(58 7%). A total of 43 patients could live by themselves Tumor disappearance was observed in 30 cases and recurrence in five cases. Five cases showed no changes in tumor size. 28 cases underwent radiotherapy after surgery and the occurrence rate of hypopituitarism after radiotherapy turned to be 50%. Total tumor control rate was calculated as 93%. Conclusions Macroadenomas and non functional pituitary adenomas happened most frequently in elderly patients and the main clinical symptoms was visual deterioration. Trans sphenoidal route for microsurgery was believed to be the first choice of operation. Tumor recurrence can be controlled or delayed by postoperative radiotherapy, but severe complication of the visual injury and pituitary dysfunction should be paid much attention.