CONTEXT: GH-secreting pituitary adenomas are nearly always visible on conventional magnetic resonance (MR) imaging. However, management and outcome of acromegalic patients lacking imaging evidence of GH-secreting pituitary adenomas are undefined. OBJECTIVE: The aim was to evaluate surgical exploration for MR-invisible GH-secreting pituitary adenomas. DESIGN AND SETTING: We conducted a retrospective review at two tertiary care centers. PATIENTS OR OTHER PARTICIPANTS: Consecutive acromegalic patients without imaging evidence of a pituitary adenoma on pre- and postcontrast, spin echo T1-weighted MR imaging and who lacked evidence of an ectopic (nonpituitary) source causing GH excess were included. INTERVENTIONS: Surgical exploration with identification and resection of a pituitary adenoma was performed. MAIN OUTCOME MEASURES: Laboratory values (GH, IGF-I), surgical findings, and clinical outcome were analyzed. RESULTS: Six patients (three males, three females; 3% of all patients) with suspected GH-secreting adenomas did not demonstrate imaging evidence of pituitary adenoma on conventional MR imaging. Three patients underwent a postcontrast, volumetric interpolated breath-hold examination MR-imaging sequence (1.2-mm slice thickness), which revealed a 4-mm pituitary adenoma not seen on the spin echo T1-weighted MR imaging in one patient. A pituitary adenoma was identified and removed in all patients (mean diameter, 5.6 mm; range, 5 to 6.7 mm). Histological analysis confirmed that the lesions were GH-secreting adenomas. All patients achieved biochemical remission after surgical resection. CONCLUSION: Acromegaly can be caused by GH-secreting pituitary adenomas that are not evident on conventional MR imaging. Adenomas in some of these patients become evident using volumetric interpolated breath-hold examination MR imaging. Surgical exploration of the pituitary gland in acromegalic patients with endocrine findings consistent with a GH-secreting adenoma but negative MR imaging can lead to identification and removal of an adenoma.
CONTEXT: GH-secreting pituitary adenomas are nearly always visible on conventional magnetic resonance (MR) imaging. However, management and outcome of acromegalicpatients lacking imaging evidence of GH-secreting pituitary adenomas are undefined. OBJECTIVE: The aim was to evaluate surgical exploration for MR-invisible GH-secreting pituitary adenomas. DESIGN AND SETTING: We conducted a retrospective review at two tertiary care centers. PATIENTS OR OTHER PARTICIPANTS: Consecutive acromegalicpatients without imaging evidence of a pituitary adenoma on pre- and postcontrast, spin echo T1-weighted MR imaging and who lacked evidence of an ectopic (nonpituitary) source causing GH excess were included. INTERVENTIONS: Surgical exploration with identification and resection of a pituitary adenoma was performed. MAIN OUTCOME MEASURES: Laboratory values (GH, IGF-I), surgical findings, and clinical outcome were analyzed. RESULTS: Six patients (three males, three females; 3% of all patients) with suspected GH-secreting adenomas did not demonstrate imaging evidence of pituitary adenoma on conventional MR imaging. Three patients underwent a postcontrast, volumetric interpolated breath-hold examination MR-imaging sequence (1.2-mm slice thickness), which revealed a 4-mm pituitary adenoma not seen on the spin echo T1-weighted MR imaging in one patient. A pituitary adenoma was identified and removed in all patients (mean diameter, 5.6 mm; range, 5 to 6.7 mm). Histological analysis confirmed that the lesions were GH-secreting adenomas. All patients achieved biochemical remission after surgical resection. CONCLUSION:Acromegaly can be caused by GH-secreting pituitary adenomas that are not evident on conventional MR imaging. Adenomas in some of these patients become evident using volumetric interpolated breath-hold examination MR imaging. Surgical exploration of the pituitary gland in acromegalicpatients with endocrine findings consistent with a GH-secreting adenoma but negative MR imaging can lead to identification and removal of an adenoma.
Authors: J L Doppman; D L Miller; N J Patronas; E H Oldfield; G R Merriam; S J Frank; M R Flack; B D Weintraub; P Gorden Journal: AJR Am J Roentgenol Date: 1990-05 Impact factor: 3.959
Authors: Nicholas Patronas; Nail Bulakbasi; Constantine A Stratakis; Antony Lafferty; Edward H Oldfield; John Doppman; Lynnette K Nieman Journal: J Clin Endocrinol Metab Date: 2003-04 Impact factor: 5.958
Authors: Sameera Daud; Amir H Hamrahian; Robert J Weil; Marwan Hamaty; Richard A Prayson; Leann Olansky Journal: Pituitary Date: 2011-12 Impact factor: 4.107
Authors: Russell R Lonser; Gautam U Mehta; Bogdan A Kindzelski; Abhik Ray-Chaudhury; Alexander O Vortmeyer; Robert Dickerman; Edward H Oldfield Journal: Neurosurgery Date: 2017-05-01 Impact factor: 4.654