Nonfunctioning pituitary adenomas in elderly patients

Background Recently, several reports have revealed new aspects regarding transsphenoidal surgery (TSS) for pituitary lesions in elderly patients. Objective The aim of present study is to provide an updated review of the recent literature, which we hope will contribute to the management of nonfunctioning pituitary adenoma (NFPA) in elderly patients. Methods We searched PubMed and Web of Science for reports on TSS for NFPAs in elderly patients and reviewed the literature. Results NFPAs, which cause the symptoms of tumor mass effect, are the most common form of pituitary adenoma in elderly individuals. The rates of tumor resection and postoperative visual improvement in elderly patients are similar to those in younger patients; however, elderly patients have greater difficulty in recovering from preoperative hypopituitarism. TSS is associated with low rates of morbidity and mortality in elderly patients. However, there is a possibility that the risks of morbidity and mortality increase with advancing age. TSS is not considered for elderly patients who show hypopituitarism alone, but who either have or are predicted to experience a tumor mass effect. Prospective MRI follow-up without surgery can be also proposed for elderly patients with a high American Society of Anesthesiologists (ASA) grade or those in whom there is no evidence of tumor growth towards the optic pathway. Conclusions TSS is considered a safe procedure for the treatment of NFPA and is even tolerated by elderly patients; however, the surgical indications, which are based on the patient’s clinical condition and the results of radiological examinations, should be strict.