This retrospective study was conducted in a central tertiary university hospital. The study was approved by the Ethics Committee of Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine. The study is in full compliance with the Declaration of Helsinki. Patient data were coded and stored anonymously.
We evaluated operated pituitary nonfunctional adenoma (NFA) cases aged 65 years and older followed up in Istanbul University Cerrahpasa, Cerrahpasa Medical Faculty, Endocrinology and Metabolism clinic between 2010 and 2022. Patients seen in the geriatric outpatient clinic with a diagnosis of hypertension were included in the study as a control group. Clinical, endocrinologic, pathologic, and radiologic findings and treatment information were obtained from the records. Bioimpedance was used to determine muscle strength, walking speed, and muscle-to-fat ratio in patients. In addition, quality of life, anxiety, depression, cognitive function, and vulnerability were assessed.
Inclusion criteria were (Ⅰ) patients aged 65 years and older, (Ⅱ) with operated non-functional pituitary adenoma, (Ⅲ) who can walk
The exclusion criteria were as follows: (Ⅰ) dementia, (Ⅱ) delirium, (Ⅲ) Parkinson's disease, (Ⅳ) ischemic and cerebrovascular vascular disease, (Ⅴ) psychiatric patients, (Ⅵ) patients who cannot walk, (Ⅶ) patients under 65 years of age, (Ⅷ) those with oncology, hematology and rheumatology disease, (Ⅸ) spinal disc herniation, (Χ) those with limited mobility due to arthrosis
Radiological Evaluation
All neuroimaging was performed in our institute using a 3T Philips Ingenia MR scanner (Philips, Best, The Netherlands) with a 16-channel head coil. The imaging protocol included coronal T1-weighted turbo spin-echo images [repetition time (TR), 300 ms; echo time (TE), 10 ms; field of view (FOV), 190x190 mm; slice thickness, 2,5 mm; matrix, 192x192), sagittal T1-weighted turbo spin-echo [repetition time (TR), 350 ms; echo time (TE), 10 ms; field of view (FOV), 190x190 mm; slice thickness, 2,5 mm; matrix, 224x320) and coronal T2-weighted turbo spin-echo (TR, 3090 ms; TE, 104 ms; FOV, 180x180 mm; slice thickness, 2,5 mm; matrix, 224x320). Dynamic contrast-enhanced coronal T1-weighted turbo field echo images (TR, 448 ms; TE, 10 ms; FOV, 190x190 mm; slice thickness, 3 mm; matrix, 224x320) were acquired 0 to 3 min after 0.1 mmol/kg of gadolinium contrast agent (Dotarem; Guerbert, SA) was fully injected at rate of 2 mL/s via an antecubital venous access.
Walking speed
Physical performance was measured with the 4-meter walking speed test. The threshold for walking speed is < 0.8 m/s (6).
Evaluation of malnutrition
Mini-nutrition test (MNA) was used to evaluate the nutritional status of the patients. If the value obtained from the MNA short form is 11 and below, the MNA long form is applied. The score obtained from this form is also: 23.5 and above are not malnutrition, 17-23.5 are considered malnutrition risk, 17 points and below are considered malnutrition (7).
Muscle strength assessment
A Jamar hand dynamometer with a gripping arm was used to determine the patient's grip strength. To determine the dominant hand, participants are asked which hand they use when eating or writing. During the measurements, participants are asked to face forward while seated, with their feet shoulder-width apart and elbows fully extended. The dynamometer is held in a comfortable grip position with the index finger flexed 90 degrees. Patients are asked to apply full force to the arm for 3 seconds. They are told not to hold their breath or shake the force meter during the test. The grip strength of the patient's dominant hand is measured three times, and the highest value is reported in kilograms (kg). There should be a pause of at least 60 seconds between each test. According to the European Working Group on Sarcopenia in the Elderly, the threshold for sarcopenia at < is 20 kg in women and < is 30 kg in men (8).
Sarcopenia assessment
In order to determine the muscle mass and body fat ratio, the patient was evaluated with the Bodystat quadscan 4000 brand bioimpedance device after 4 hours of fasting. In measurements made with bioimpedance, there is a reference range for muscle and fat mass according to gender and age range (9).
Examination of fragility
To determine the fragility of the patients, the Fried test questionnaire, valid and reliable in our country, was performed. Fried test: 1. 5-metre walking speed test (slow > 6 sec, very slow > 7.7 sec, forward slow > 10 sec., 2. Grip strength test: female < 20 kg, male < 30 kg, 3: No physical activity in the past year, mostly sedentary or infrequent short walking, 4-Weakness: feeling of difficulty in all daily activities on at least 3 days in the past week or inability to start activities, 5-Weight loss: involuntary weight loss in the past year > 4.5 kg The presence of 3 or more of the criteria is defined as frailty syndrome. The presence of 1 and 2 is interpreted as predisposition to frailty (10).
Examination of cognition
A minimental test was performed to evaluate the patients' cognitive performance. The test is scored at 30 points. Those with a normal score of 24–30, mild dementia of 18–23, moderate dementia of 17 − 13, and a score of 12 and below are classified as advanced dementia (11).
Quality of life evaluation
The general quality of life scale EQ -5D-5L was used to assess quality of life. It consists of two parts; Chap. 1 defines the health profile in five dimensions: mobility, self-care, social life, pain, and psychological state. According to each dimension grade; It contains 5 statements as 0 no problem, 1 mild problem, 2 moderate problems, 4 severe problems, 5 extreme problems. Section 2 evaluates their current state of health on a scale of 0 to 100 (12).
Depression and anxiety evaluation
The geriatric depression scale includes 30 questions; 10 and below is interpreted as normal, 11–13 points as probable depression, and 14–30 points as definite depression.
The Beck anxiety scale was used to assess patient anxiety. Consisting of 21 questions and each question has never been answered 0 points, mildly but it did not affect me 1 point, it affected me moderately, it was not pleasant but I could bear it 2 points and it affected seriously, I had a hard time enduring it as 3 points interpreted. 0–7 points as no anxiety, 8–15 points as mild anxiety, 16–25 points as moderate anxiety, 26–63 points as severe anxiety (13).
Statistical Analysis
Statistical analyzes were carry out with the Statistical Package for the Social Sciences (SPSS) software (version 21.0). Data were evaluated for normality with the Kolmogorov-Smirnov test. Continuous variables were expressed as mean ± standard deviation (SD) and/or median (interquartile range [IQR]). Student's t test was used when comparing groups with normal data distribution. Medians were compared with the Mann-Whitney U test and the Kruskal-Wallis test. Correlation between variables according to the distribution of the data was calculated using Spearman and Pearson tests. The results were evaluated at the 95% confidence interval. P value < 0.05 was considered statistically significant.
Sample size
Required sample size was calculated as 102 for 2-tailed t test with 5% significance level to achieve 80% power.