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Acromegaly without imaging evidence of pituitary adenoma.
J Clin Endocrinol Metab. 2010 Sep; 95(9):4192-6.JC

Abstract

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.

Authors+Show Affiliations

Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Building 10, Room 3D20, Bethesda, Maryland 20892-1414, USA. lonserr@ninds.nih.govNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Multicenter Study
Research Support, N.I.H., Intramural

Language

eng

PubMed ID

20610592

Citation

Lonser, Russell R., et al. "Acromegaly Without Imaging Evidence of Pituitary Adenoma." The Journal of Clinical Endocrinology and Metabolism, vol. 95, no. 9, 2010, pp. 4192-6.
Lonser RR, Kindzelski BA, Mehta GU, et al. Acromegaly without imaging evidence of pituitary adenoma. J Clin Endocrinol Metab. 2010;95(9):4192-6.
Lonser, R. R., Kindzelski, B. A., Mehta, G. U., Jane, J. A., & Oldfield, E. H. (2010). Acromegaly without imaging evidence of pituitary adenoma. The Journal of Clinical Endocrinology and Metabolism, 95(9), 4192-6. https://doi.org/10.1210/jc.2010-0570
Lonser RR, et al. Acromegaly Without Imaging Evidence of Pituitary Adenoma. J Clin Endocrinol Metab. 2010;95(9):4192-6. PubMed PMID: 20610592.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acromegaly without imaging evidence of pituitary adenoma. AU - Lonser,Russell R, AU - Kindzelski,Bogdan A, AU - Mehta,Gautam U, AU - Jane,John A,Jr AU - Oldfield,Edward H, Y1 - 2010/07/07/ PY - 2010/7/9/entrez PY - 2010/7/9/pubmed PY - 2010/9/30/medline SP - 4192 EP - 6 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 95 IS - 9 N2 - 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. SN - 1945-7197 UR - https://www.unboundmedicine.com/medline/citation/20610592/Acromegaly_without_imaging_evidence_of_pituitary_adenoma_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2010-0570 DB - PRIME DP - Unbound Medicine ER -