Acromegaly without Imaging Evidence of Pituitary Adenoma

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 explorati...

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Bibliographic Details
Published in:The journal of clinical endocrinology and metabolism 2010-09, Vol.95 (9), p.4192-4196
Main Authors: Lonser, Russell R, Kindzelski, Bogdan A, Mehta, Gautam U, Jane, John A, Oldfield, Edward H
Format: Article
Language:English
Subjects:
Acromegaly - diagnostic imaging
Acromegaly - etiology
Adenoma - complications
Adenoma - diagnostic imaging
Adenoma - pathology
Adenoma - surgery
Adult
Aged
Biological and medical sciences
Diagnosis, Differential
Endocrinopathies
Extensive Clinical Experience
False Negative Reactions
Feeding. Feeding behavior
Female
Fundamental and applied biological sciences. Psychology
Growth Hormone-Secreting Pituitary Adenoma - complications
Growth Hormone-Secreting Pituitary Adenoma - diagnostic imaging
Growth Hormone-Secreting Pituitary Adenoma - pathology
Growth Hormone-Secreting Pituitary Adenoma - surgery
Humans
Hypothalamus. Hypophysis. Epiphysis (diseases)
Magnetic Resonance Imaging
Male
Medical sciences
Middle Aged
Non tumoral diseases. Target tissue resistance. Benign neoplasms
Radiography
Retrospective Studies
Tumor Burden
Vertebrates: anatomy and physiology, studies on body, several organs or systems
Vertebrates: endocrinology
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Description
Summary: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. Acromegalic patients with a suspected GH-secreting pituitary adenoma but negative magnetic resonance imaging should undergo surgical exploration, which can lead to tumor removal with biochemical remission.
ISSN:0021-972X
1945-7197
DOI:10.1210/jc.2010-0570