Pituitary Surgery Outcome in Patients 75 Years and Older

Posted on October 5, 2023 by MaryO

Abstract

Background

As the population ages, the number of elderly patients with an indication for pituitary surgery is rising. Information on the outcome of patients aged over 75 is limited. This study reports a large series assessing the feasibility of surgical resection in this specific age range, focusing on surgical complications and postoperative results.

Methods

A retrospective cohort study of patients with pituitary adenomas and Rathke’s cleft cysts was conducted. All patients were aged 75 years or over and treated by a single expert neurosurgical team. A control population included 2379 younger adult patients operated by the same surgeons during the same period.

Results

Between 2008 and 2022, 155 patients underwent surgery. Indication was based on vision impairment in most patients (79%). Median follow-up was 13 months (range: 3–96). The first surgery was performed with an endoscopic transsellar approach, an extended endonasal transtuberculum approach and a microscopic transcranial approach in 96%, 3%, and 1% of patients, respectively. Single surgery was sufficient to obtain volume control in 97% of patients. From Kaplan-Meier estimates, 2-year and 5-year disease control with a single surgery were 97.3% and 86.2%, respectively. Resection higher than 80% was achieved in 77% of patients. No vision worsening occurred. In acromegaly and Cushing’s disease, endocrine remission was obtained in 90% of non-invasive adenomas. Surgical complications were noted in 5% of patients, with 30-day mortality, hematoma, cerebrospinal fluid leak, meningitis, and epistaxis occurring in 0.6%, 0.6%, 1.9%, 0.6%, and 1.3% respectively. New endocrine anterior deficits occurred in only 5%, while no persistent diabetes insipidus was noted. Compared with younger patients, the complication rate was not statistically different.

Conclusions

Surgery beyond the age of 75, mainly relying on an endoscopic endonasal transsellar approach, is effective and safe, provided that patients are managed in tertiary centers.

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Abbreviations

CSF:
Cerebrospinal fluid
ASA:
American Society of Anesthesiologists Physical Status Classification System

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de L’Hôpital, 75013, Paris, France

    Marta Garvayo, Vincent Reina, Stephan Gaillard & Bertrand Baussart

  2. Department of Neurosurgery, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland

    Marta Garvayo & Mahmoud Messerer

  3. Université Paris Cité, CNRS, INSERM, Institut Cochin, 75014, Paris, France

    Chiara Villa, Anne Jouinot, Jérôme Bertherat, Guillaume Assié & Bertrand Baussart

  4. Department of Neuropathology, La Pitié-Salpêtière University Hospital, AP-HP, Sorbonne University, Paris, France

    Chiara Villa

  5. Department of Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne Billancourt, France

    Mirella Hage & Marie-Laure Raffin-Sanson

  6. Université de Versailles Saint-Quentin-en-Yvelines UFR Des Sciences de La Santé Simone Veil, Montigny-Le-Bretonneux, France

    Mirella Hage & Marie-Laure Raffin-Sanson

  7. Department of Endocrinology and Reproductive Medicine, Centre de Référence Des Maladies Endocriniennes Rares de La Croissance Et du Développement, CRMERC, Endo-ERN, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France

    Carine Courtillot & Anne Bachelot

  8. Université Paris-Saclay, Inserm, Physiologie Et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie Et Des Maladies de La Reproduction, Centre de Référence des Maladies Rares de L’Hypophyse, Le Kremlin-Bicêtre, France

    Peter Kamenicky & Philippe Chanson

  9. Sorbonne University, Endocrine Unit, Reproductive Medicine, Centre de Référence Des Maladies Endocriniennes Rares de La Croissance Et du Développement (CRMERC), Endo-ERN (Id 739527), Saint-Antoine Hospital, AP-HP, Paris, France

    Camille Vatier & Sophie Christin-Maitre

  10. Inserm UMRS938, Saint-Antoine Research Center, Sorbonne University, 75012, Paris, France

    Camille Vatier

  11. INSERM UMR-833, Trousseau Hospital, Paris, France

    Sophie Christin-Maitre

  12. Department of Endocrinology, Center of Rare Adrenal Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France

    Jérôme Bertherat & Guillaume Assié

Corresponding author

Correspondence to Bertrand Baussart.

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Conflict of interest

The authors declare no competing interests.

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From https://link.springer.com/article/10.1007/s00701-023-05809-x

Filed under: Cushing's, pituitary, Treatments | Tagged: , , | Leave a comment »

Pituitary Tumors Affect Patients’ Ability to Work, Reduce Quality of Life

Posted on November 10, 2018 by MaryO

Pituitary tumor conditions, such as Cushing’s disease, have a substantial effect on patients’ work capabilities and health-related quality of life, researchers from The Netherlands reported.

The study, “Work disability and its determinants in patients with pituitary tumor-related disease,” was published in the journal Pituitary.

Pituitary tumors, like those that cause Cushing’s disease, have significant effects on a patient’s physical, mental, and social health, all of which influence their work status and health-related quality of life. However, the effects of the disease on work status is relatively under-investigated, investigators report.

Here, researchers evaluated the work disability among patients who were treated for pituitary tumors in an attempt to understand the impact of disease diagnosis and treatment on their social participation and ability to maintain a paying job.

In their study, researchers examined 241 patients (61% women) with a median age of 53 years. The majority (27%) had non-functioning pituitary tumors, which do not produce excess hormones, but patients with acromegaly, Cushing’s disease, prolactinomas, and Rathke’s cleft cyst also were included.

Participants were asked to complete questionnaires to evaluate their health-related quality of life and disease-specific impact on their work capabilities. Each participant completed a set of five questionnaires.

Participants also reported their hormonal status and demographic data, including gender, age, education, and marital status. Specific information, such as disease diagnosis, treatment, and tumor type was obtained from their medical records.

Work status and productivity were assessed using two surveys, the Short-Form-Health and Labour Questionnaire (SF-HLQ) and the work role functioning questionnaire 2.0 (WRFQ).

SF-HLQ was used to obtain information on the participants’ employment and their work attendance. Employment was either paid or unpaid. (Participation in household chores was considered not having a paid job.)

WRFQ is a 27-question survey that determines work disability regarding being able to meet the productivity, physical, emotional, social, and flexible demands. A higher score indicates low self-perceived work disability.

Disease-specific mood problems, social and sexual functioning issues, negative perceptions due to illness, physical and cognitive difficulties, were assessed using a 26-item survey called Leiden Bother and Needs for Support Questionnaire for pituitary patients(LBNQ-Pituitary).

Overall, 28% of patients did not have a paid job, but the rates increased to 47% among those with Cushing’s disease. Low education, hormonal deficits, and being single were identified as the most common determinants of not having a paid job among this population.

Further analysis revealed that more patients with Cushing’s disease and acromegaly had undergone radiotherapy. They also had more hormonal deficits than others with different tumor types.

Overall, patients with a paid job reported working a median of 36 hours in one week and 41% of those patients missed work an average of 27 days during the previous year. Health-related problems during work also were reported by 39% with a paid job.

Finally, health-related quality of life was determined using two questionnaires: SF-36 and EQ-5D. The physical, mental, and emotional well being was measured with SF-36, while ED-5D measured the health outcome based on the impact of pain, mobility, self-care, usual activities, discomfort, and anxiety or depression. In both SF-36 and EQ-5D, a higher score indicates a better health status.

Statistical analysis revealed that the quality of life was significantly higher in patients with a job. Overall, patients with a paid job reported better health status and higher quality of life than those without a paid job.

Although 40% of the patients reported being bothered by health-related problems in the past year, only 12% sought the help of an occupational physician, the researchers reported.

“Work disability among patients with a pituitary tumor is substantial,” investigators said.

“The determinants and difficulties at work found in this study could potentially be used for further research, and we advise healthcare professionals to take these results into consideration in the clinical guidance of patients,” they concluded.

From https://cushingsdiseasenews.com/

Filed under: Cushing's, pituitary, symptoms | Tagged: , , , , , | 2 Comments »

Topical Steroid Use in Psoriasis Patient Leads to Severe Adrenal Insufficiency

Posted on May 5, 2017 by MaryO

This article is written live from the American Association of Clinical Endocrinologists (AACE) 2017 Annual Meeting in Austin, TX. MPR will be reporting news on the latest findings from leading experts in endocrinology. Check back for more news from AACE 2017.

 

At the AACE 2017 Annual Meeting, lead study author Kaitlyn Steffensmeier, MS III, of the Dayton Veterans Affairs (VA) Medical Center, Dayton, OH, presented a case study describing a patient “who developed secondary adrenal insufficiency secondary to long-term topical steroid use and who with decreased topical steroid use recovered.”

The patient was a 63-year-old white male with a 23-year history of psoriasis. For 18 years, the patient had been applying Clobetasol Propionate 0.05% topically on several areas of his body every day. Upon presentation to the endocrine clinic for evaluation of his low serum cortisol, the patient complained of a 24-pound weight gain over a 2-year period, feeling fatigued, as well as facial puffiness.

Laboratory analysis found that the patient’s random serum cortisol and ACTH levels were low (0.2µg/dL and <1.1pg/mL, respectively). According to the study authors, “the labs were indicative of secondary adrenal insufficiency.” Additionally, a pituitary MRI “showed a 2mm hypoenhancing lesion within the midline of the pituitary gland consistent with Rathke’s cleft cyst versus pituitary microadenoma.”

The patient was initiated on 10mg of hydrocortisone in the morning and 5mg in the evening and was instructed to decrease the use of his topical steroid to one time per month. For the treatment of his psoriasis, the patient was started on apremilast, a phosphodiesterase-4 enzyme (PDE4) inhibitor, and phototherapy.

After 2.5 years, the patient had a subnormal response to the cosyntropin stimulation test. However, after 3 years, a normal response with an increase in serum cortisol to 18.7µg/dL at 60 minutes was obtained; the patient was then discontinued on hydrocortisone. Additionally, a stable pituitary tumor was shown via a repeat pituitary MRI.

The study authors explained that, although secondary adrenal insufficiency is not commonly reported, “one study showed 40% of patients with abnormal cortisol response to exogenous ACTH after two weeks of topical glucocorticoids usage.” Another meta-analysis of 15 studies (n=320) revealed 4.7% of patients developing adrenal insufficiency after using topical steroids. Because of this, “clinicians need to be aware of potential side effects of prolong topical steroid use,” added the study authors.

For continuous endocrine news coverage from the AACE 2017 Annual Meeting, check back to MPR’s AACE page for the latest updates.

From http://www.empr.com/aace-2017/topical-steroid-psoriasis-clobestasol-propionate/article/654335/

Filed under: AACE 2017 Annual Meeting, adrenal, Meetings and Conferences, pituitary | Tagged: , , , , , , , , , , , , | Leave a comment »

Other Diseases

Posted on February 21, 2015 by MaryO

forums

Many of the people who post on the message boards suffer from other diseases, as well as Cushing’s. These links help to provide some information about these diseases.

~A ~

Acanthosis nigricans
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Acromegaly
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Addison’s Disease
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Adrenoleukodystrophy
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~B ~

Barrett’s esophagus

~C ~

Carney Complex
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New Support Group for Carney Complex.

Central Serous Retinopathy
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Congenital Adrenal Hyperplasia (CAH)
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Conn’s Syndrome
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Craniopharyngioma
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~D ~

Diabetes insipidus
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~E ~

Ectopic ACTH Syndrome
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Empty Sella
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~F ~

Fibromyalgia
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~G ~

Gigantism
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~H ~

Hirsuitism
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Hyperprolactinemia
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Hyperthyroidism
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Hypoalderostonism
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Hypocalcemia
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Hypopituitarism
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Hypothyroidism
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~I ~

Insulin Resistance
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~K ~

Kidney Disease
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~L ~

Lyme Disease
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~M ~

Madelung’s Disease
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Menopause
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MEN Type 1
This Topic on the Message Boards.

Myasthenia Gravis
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~N ~

Nelson’s Syndrome
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~O ~

Osteopenia
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Osteoporosis
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~P ~

Panhypopituitarism
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PCOS
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Perimenopause
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Pheochromocytoma
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Pituitary dwarfism
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Premature menopause
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Primary pigmented nodular adrenocortical disease (PPNAD)
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Prolactinoma
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Pseudo Cushing’s
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~R ~

Rathke’s cleft cyst
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ROHHAD (Rapid-Onset Obesity With Hypothalamic Dysfunction, Hypoventilation, and Autonomic Dysregulation Presenting in Childhood)
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~S ~

Sheehan’s Syndrome
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Stein-Leventhal Syndrome
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~T ~

Thymoma
This Topic on the Message Boards.

Thyroid Gland Disorders
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Turner’s Syndrome
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~V ~

Von Hippel-Lindau disease
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~Z ~

Zollinger-Ellison Syndrome

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