Skip to main content
SpringerLink
Log in

Factors predicting pituitary adenoma invasiveness in acromegalic patients

  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Forty-four adult acromegalic patients carrying growth hormone-producing pituitary macroadenomas were investigated with neuroradiological and endocrinological techniques. Plasma growth hormone and somatomedin-C levels were repeatedly measured before surgical removal of tumors and during the follow-up period. Twenty-five patients presented preoperatively with an invasive adenoma that involved the cavernous sinus (CS). Diagnosis of tumor invasivity was made according to distinct neuroradiological criteria and was confirmed or rejected during surgery. Significantly higher basal growth hormone levels were found in patients with CS invasion than in cases without tumor growth in the CS. Evidence is presented that plasma growth hormone level in acromegalics is a more sensitive indicator for predicting tumor invasiveness than somatomedin-C. Growth hormone basal values before surgery and the extent of their decrease after removal of tumor correlate with adenoma growth in the parasellar compartments and should be used as a prognostic factor to aid in planing adjuvant tumor treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ahmadi J, C North, H Segall, C Zee, M Weiss: Cavernous sinus invasion by pituitary adenomas. Am J Radiol 146 (1986) 257–262

    Google Scholar 

  2. Arafah BM, JL Rosenzweig, R Fenstermaker, R Salazar, C Mcbride, W Selman: Value of growth hormone dynamics and somatomedin C (insulin-like growth factor 1) levels in predicting the long-term benefit after transsphenoidal surgery for acromegaly. J Lab Clin Med 9 (1987) 346–354

    Google Scholar 

  3. Basso S, E Berner, E Caputi, C Yampolsky: Pituitary adenoma with cavernous sinus involvement. In: Samii M (ed) Surgery of the sellar region and parasellar sinuses. Springer Wien, (1987) 86–93

    Google Scholar 

  4. Buchfelder M: Prognostische Faktoren bei hormonaktiven Hypophysenadenomen. Klinische und experimentelle Untersuchungen. W Zuekschwerdt Verlag, München Bern Wien New York, 1993

    Google Scholar 

  5. Buchfelder M, R Fahlbusch: Transsphenoidal surgery of pituitary adenomas developed towards the cavernous sinus In: Dolenc VV (ed) The cavernous sinus. Springer Wien, 1982, 404–414

    Google Scholar 

  6. Couldwell ET, MF Sinard, MH Weiss: Management of pituitary adenomas. Neurosurg Quart 4 (1994) 249–274

    Google Scholar 

  7. Davis DH, ER Laws JR, DM Ilstrup, JK Speed, M Caruso, EG Shaw, CF Abboud, BW Scheithauer, LM Root, C Schleck: Results of surgical treatment for growth hormone-secreting pituitary adenomas. J Neurosurg 79 (1993) 70–75

    PubMed  Google Scholar 

  8. Ezzat S, E Horvath, AG Harris, K Kovacs: Morphological effects of octreotide on growth hormoneproducing pituitary adenomas. J Clin Endocrinol Metab 79 (1994) 114–118

    Google Scholar 

  9. Fahlbusch R, M Buchfelder: Transsphenoidal surgery of parasellar pituitary adenomas. Acta Neurochir 92 (1988) 93–99

    Google Scholar 

  10. Fahlbusch R, M Buchfelder, WJ Huk, R Nistor, R Steinmeier, A Zrinzo: Correlation between MRI and intraoperative findings in pituitary adenomas. In: Faglia G, Beck-Peccoz P, Ambrosi B, Travaglini P, Spada A (eds) Pituitary adenomas. New trends in basic and clinical research. Excerpta Medica Amsterdam, 1991, 245–253

    Google Scholar 

  11. Fahlbusch R, J Honegger, M Buchfelder: Surgical treatment of acromegaly. Endocrinol Metab North Am 21 (1992) 669–692

    Google Scholar 

  12. Fraioli B, G Esposito, A Santoro, R Giufere, G Cantors: Transmaxillosphenoidal approach to tumors invading the medial compartment of the cavernous sinus. J Neurosurg 82 (1995) 63–69

    PubMed  Google Scholar 

  13. Grisou F, T Leclercq, P Jaquet, M Guibout, JP Winteler, J Hassdun, F Vincentelli: Transsphenoidal surgery for acromegaly - long-term results in 100 patients. Surg Neurol 23 (1985) 513–519

    PubMed  Google Scholar 

  14. Hall WA, MG Luciano, JL Doppman, NJ Patronas, EH Oldfield: Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population. Ann Int Med 120 (1994) 817–820

    PubMed  Google Scholar 

  15. Hardy J: Transsphenoidal surgery of hypersecretory pituitary tumors. In: Kohler PO, Ross GT (eds) Diagnosis and treatment of pituitary tumors. Excerpta Medica Amsterdam, 1973, 179–194

    Google Scholar 

  16. Horvath E, K Kovacs: Pituitary gland. Pathol Res Pract 183 (1988) 129–142

    PubMed  Google Scholar 

  17. Knosp E, K Kitz, E Steiner, C Matula: Pituitary adenomas with parasellar invasion. Acta Neurochir Suppl 53 (1991) 65–71

    Google Scholar 

  18. Knosp E, C Matula: Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 33 (1993) 610–618

    PubMed  Google Scholar 

  19. Kovacs K, E Horvath: Pathology of growth hormone producing tumors of the human pituitary. Semin Diagn Pathol 3 (1986) 18–23

    PubMed  Google Scholar 

  20. Lamberts SWJ, P Uitterlinden, L Verschoor, KJ van Dongen, E del Pozo E: Long-term treatment of acromegaly with the somatostatin analogue SMS 210–995. N Engl J Med 313 (1985) 1576–1578

    PubMed  Google Scholar 

  21. Landout AM, R Illig, J Zapf: Surgical treatment of acromegaly. In: Lamberts SWJ (ed) Sandostatin in the treatment of acromegaly. Springer Berlin Heidelberg New York, 1990, 23–35

    Google Scholar 

  22. Landolt AM, T Shibata, P Kleihues: Growth rate of human pituitary adenomas. J Neurosurg 67 (1987) 803–806

    PubMed  Google Scholar 

  23. Laws ER Jr: Neurosurgical management of acromegaly. In: Cooper PR (ed) Contemporary diagnosis and management of pituitary adenomas. AANS Publication Committee, Park Ridge, 1991, 53–59

    Google Scholar 

  24. Lindholm J, B Giwercman, A Giwercman, A Astrup, P Bierre, S Skakkebaek: Investigation of the criteria for assessing the outcome of treatment in acromegaly. Clin Endocrinol 27 (1987) 553–562

    Google Scholar 

  25. Losa M, R Oeckler, J Schopohl, A Moller, J Alga-Lopez, K von Werder: Evaluation of selective transsphenoidal adenomectomy by endocrino logical testing and somatomedin-C measurement in acromegaly. J Neurosurg 70 (1989) 561–567

    PubMed  Google Scholar 

  26. Melmed S: Acromegaly. N Engl J Med 322 (1990) 966–972

    PubMed  Google Scholar 

  27. Peck WW, WP Dillon, D Norman, TH Newton, CB Wilson: High-resolution MR imaging of microadenomas at 1.5 T experience with Cushing's disease. Am J Neuroradiol 9 (1988) 1085–1901

    Google Scholar 

  28. Pichl J, U Schrell: Basal serum somatomedin C measurements as indicator of successful adenomectomy in acromegaly. Acta Endocrinol Suppl. 274 (1986) 27–28

    Google Scholar 

  29. Ross DA, CB Wilson: Results of transsphenoidal microsurgery for growth hormone-secreting pituitary adenoma in a series of 214 patients. J Neurosurg 68 (1988) 854–867

    PubMed  Google Scholar 

  30. Sautner D, W Saeger: Invasiveness of pituitary adenomas. Pathol Res Pract 187 (1991) 632–636

    PubMed  Google Scholar 

  31. Scheithauer BW, KT Kovacs, ER Laws Jr, RV Randall: Pathology of invasive pituitary tumors with special reference to functional classification. J Neurosurg 65 (1986) 733–744

    PubMed  Google Scholar 

  32. Scotti G, Y Chin-Yin, D Norman, N Colombo, T Newton, J Groot: MRI imaging of cavernous sinus involvement by pituitary adenomas. Am J Neuroradiol 9 (1988) 657–664

    Google Scholar 

  33. Selman W, ER Laws Jr, BW Scheithauer, SM Carpenter: The occurrence of dural invasion in pituitary adenomas. J Neurosurg 64 (1986) 402–407

    PubMed  Google Scholar 

  34. Serri O, M Somma, R Comtois, E Rasio, H Beauregard, N Jilwan, J Hardy. Acromegaly: biochemical assessment of cure after long-term follow-up of transsphenoidal selective adenomectomy. J Clin Endocrinol Metab 61 (1985) 1185–1189

    PubMed  Google Scholar 

  35. Sumida M, T Uozumi, K Mukada, K Arita, K Kurisu, T Yano, J Onda, H Satoh, F Ikawa: MRI of pituitary adenomas: the position of the normal pituitary gland. Neuroradiol 36 (1994) 295–297

    Google Scholar 

  36. Teasdale E, G Teasdale, F Mohsen, P Macpherson: High-resolution computed tomography in pituitary microadenomas: is seeing believing? Clin Radiol 37 (1986)227–232

    PubMed  Google Scholar 

  37. Tindal GT, N Oyesiku, N Watts, R Clark, J Christ, D Adams: Transsphenoidal adenomectomy for growth hormone secreting pituitary adenomas in acromegaly: outcome analysis and determinants of failure. J Neurosurg 78 (1993) 205–215

    PubMed  Google Scholar 

  38. Wass JA, ER Laws Jr, RV Randal, GE Sheline: The treatment of acromegaly. J Clin Endocrinol Metab 15 (1986) 683–707

    Google Scholar 

  39. Wilson CB: Neurosurgical management of large and invasive pituitary tumors. In: Tindall GT, Collins WF (eds) Clinical management of pituitary disorders. Raven Press Ltd New York, 1979, 335–342

    Google Scholar 

  40. Wright AD, DM Hill, C Lowy, RT Fraser: Mortality in acromegaly. Q J Med 39 (1970) 1–16

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Martin-Luther-University Halle, Magdeburger Str. 16, D-06097, Halle/Saale, Germany

    Andreas Rieger, Nikolai G. Rainov, Lhagva Sanchin, Khalid Shibib & Winfried Burkert

  2. Neurosurgical Clinic, Medical Faculty, Justus-Liebig-University, Gießen

    Heinrich Ebel & Christiane Helfrich

  3. Division for Medical Information, Medical College Gießen, Germany

    Olaf Hoffmann

Authors
  1. Andreas Rieger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nikolai G. Rainov
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Heinrich Ebel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lhagva Sanchin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Khalid Shibib
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christiane Helfrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Olaf Hoffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Winfried Burkert
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rieger, A., Rainov, N.G., Ebel, H. et al. Factors predicting pituitary adenoma invasiveness in acromegalic patients. Neurosurg. Rev. 20, 182–187 (1997). https://doi.org/10.1007/BF01105562

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01105562

Keywords

Search

Navigation