Weiming Liu1, Hui Zhou2, Marian Christoph Neidert3, Christoph Schmid4, René-Ludwig Bernays5, Ming Ni1, Dabiao Zhou1, Wang Jia1, Guijun Jia6. 1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, 100050 Beijing, China. 2. Department of Neurosurgery, The First People Hospital of Lianyungang, Tongguan Beilu 182, 222002 Lianyungan, Jiangsu, China. 3. Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091 Zurich, Switzerland. 4. Division of Endocrinology and Diabetes, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland. 5. Neurochirurgie Klinik Hirslanden, Witellikerstrasse 40, CH-8032 Zurich, Switzerland. 6. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, 100050 Beijing, China. Electronic address: jiaguijun@cssc.net.cn.
Abstract
OBJECTIVE: To describe an association of growth hormone (GH) secreting pituitary microadenomas and empty sella (ES), which has been described in case reports - the underlying mechanisms are unclear. METHODS: We retrospectively analyzed patients operated for GH-producing pituitary adenomas between February 2004 and February 2009. Magnetic resonance imaging (MRI), computed tomography (CT) imaging, and pituitary function testing were performed. All cases underwent transsphenoidal surgery (TSS). Mean follow up was 38 months (range 12-80 months). RESULTS: Out of 152 patients with acromegaly due to GH-producing pituitary adenomas (female:male=73:79; age range 17-63 years), 69 patients had microadenomas (45.4%; 38 females, 31 males). We found 14 cases (14/69, 20.3%), all microadenomas, with presurgical evidence of ES - 10 females (71%) and 4 males (29%) (female:male=2.5:1). When compared with 103 patients with GH-negative microadenomas treated in the same time period (ES in 4 of 103; 3.9%), ES was highly significantly associated with GH production by the microadenoma (p=0.001). In acromegalics with empty sella, no cases of ectopic adenoma were found. Postoperatively, GH and IGF-1 levels fell in all patients, and 7 cases had random GH and IGF-1 levels consistent with cure. CONCLUSION: The combination of GH-producing microadenomas and empty, enlarged sella is not rare. In this setting, preoperative CT scans are very useful and the transsphenoidal approach is efficient and safe. The mechanism underlying the association of GH-producing microadenomas and empty sella remains unclear and requires further studies.
OBJECTIVE: To describe an association of growth hormone (GH) secreting pituitary microadenomas and empty sella (ES), which has been described in case reports - the underlying mechanisms are unclear. METHODS: We retrospectively analyzed patients operated for GH-producing pituitary adenomas between February 2004 and February 2009. Magnetic resonance imaging (MRI), computed tomography (CT) imaging, and pituitary function testing were performed. All cases underwent transsphenoidal surgery (TSS). Mean follow up was 38 months (range 12-80 months). RESULTS: Out of 152 patients with acromegaly due to GH-producing pituitary adenomas (female:male=73:79; age range 17-63 years), 69 patients had microadenomas (45.4%; 38 females, 31 males). We found 14 cases (14/69, 20.3%), all microadenomas, with presurgical evidence of ES - 10 females (71%) and 4 males (29%) (female:male=2.5:1). When compared with 103 patients with GH-negative microadenomas treated in the same time period (ES in 4 of 103; 3.9%), ES was highly significantly associated with GH production by the microadenoma (p=0.001). In acromegalics with empty sella, no cases of ectopic adenoma were found. Postoperatively, GH and IGF-1 levels fell in all patients, and 7 cases had random GH and IGF-1 levels consistent with cure. CONCLUSION: The combination of GH-producing microadenomas and empty, enlarged sella is not rare. In this setting, preoperative CT scans are very useful and the transsphenoidal approach is efficient and safe. The mechanism underlying the association of GH-producing microadenomas and empty sella remains unclear and requires further studies.
Authors: Bobby A Tajudeen; Edward C Kuan; Nithin D Adappa; Joseph K Han; Rakesh K Chandra; James N Palmer; David W Kennedy; Marilene B Wang; Jeffrey D Suh Journal: J Neurol Surg B Skull Base Date: 2016-09-09
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