PITUITARY SURGERY IN ELDERLY PATIENTS WITH ACROMEGALY

BECAUSE OF THE common belief that there is an increase in surgical ris k and morbidity involved in the surgical therapy of elderly patients w ith acromegaly, physicians tend to either neglect therapy altogether o r choose radiation therapy combined with medical treatment. In conside ration of the expected increasing number of elderly patients resulting from social structure change in the coming years, we decided to inves tigate the outcome in 15 patients with acromegaly (13 women and 2 men) older than 64 years (mean, 68.3 yr) at the time of surgery in the for m of a retrospective study. Medical treatment using either dopamine ag onists (9 patients) and/or octreotide (4 patients) were attempted in 1 1 patients. For various reasons, however, medical therapy could not be permanently continued in any of these patients, The mean preoperative growth hormone (CH)-plasma level without medical treatment was 47.4 /- 64.2 (mean +/- standard deviation) mu g/L. At the time of operation , 13 of 15 patients had additional diseases, which led to an increased anesthesiological risk. Transnasal tumor removal was performed withou t anesthesiological or surgical complications in all patients. The rad icality of tumor removal was controlled intraoperatively by GH measure ments in eight patients. There was no postoperative mortality or serio us morbidity. Postoperative basal GH-plasma levels were normal (<4.5 m u g/L) in all patients. None of the 13 patients who participated in lo ng-term follow-up examinations (mean, 4.2 yr) revealed signs of defini te tumor recurrence. The mean GH-plasma level at follow-up was 1.6 +/- 0.9 (mean +/- Standard deviation) mu g/L. One patient died 2 years af ter the operation of causes unrelated to pituitary surgery. The subjec tively perceived benefit of surgery was stated to be high by all 13 pa tients asked. For this reason, we conclude that pituitary surgery is t he treatment of choice even in elderly patients with acromegaly.