Comparison of Pituitary Adenomas in Elderly and Younger Adults: Clinical Characteristics, Surgical Outcomes, and Prognosis
Comparison of Pituitary Adenomas in Elderly and Younger Adults: Clinical Characteristics, Surgical Outcomes, and Prognosis
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老年人和年轻人垂体腺瘤的比较：临床特征、手术结果和预后
DOI：
10.1111/jgs.13590
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发表时间：
2015-09-01
影响因子：
6.3
通讯作者：
Lei, Ting
中科院分区：
文献类型：
--
作者：
Liu, Junfeng;Li, Chaoxi;Lei, Ting
目的：分析和总结老年垂体腺瘤 (PAs) 的临床特征、手术结果和预后。设计：回顾性队列研究。地点：同济医院。参与者：2009 年至 2012 年间接受经蝶垂体腺瘤手术的个体 (N = 1,104)。测量：参与者分为两个年龄组（≥ 65 岁和 < 65），对其临床特征、手术并发症、手术结果和随访数据进行分析和比较。结果：老年组症状持续时间较长。最常见的症状是老年组的肿块效应（98.4%）和年轻组的激素分泌效应（55.2%）。垂体卒中 (P = .03)、偶发瘤 (P = .03) 和初诊误诊 (P < .001) 的发生率在老年组中较高。无功能 PA (P < .001) 和巨大腺瘤 (P = .04) 在老年组中比年轻组更常见。各组之间术后尿崩症、脑脊液 (CSF) 漏、再生长、视力结果或永久性垂体功能低下的发生率没有显着差异 (P > .05)。老年组严重全身并发症的发生率较高（3/69 vs 3/1,035，相对风险 = 15.00，95% 置信区间 = 3.08-72.94，P = .004），且老年组的所有 3 例病例均发生在急诊手术后。老年组术前和术后3天垂体功能低下的发生率较高（P < .05）。年龄较大的参与者往往更难从术前垂体功能减退中恢复 (P = .02)。结论：避免误诊和紧急手术对于患有多种合并症的体弱老年人至关重要。通过早期积极管理、充分的术前准备和多学科协作，老年 PA 患者的长期结局和预后与年轻人相当。
OBJECTIVES: To analyze and summarize the clinical characteristics, surgical outcomes, and prognosis of elderly adults with pituitary adenomas (PAs).DESIGN: Retrospective cohort study.SETTING: Tongji Hospital.PARTICIPANTS: Individuals who underwent transsphenoidal surgery for PAs between 2009 and 2012 (N = 1,104).MEASUREMENTS: 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).CONCLUSION: 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.