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Growth hormone secreting pituitary microadenomas and empty sella - An under-recognized association?
Clin Neurol Neurosurg. 2014 Nov; 126:18-23.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.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Liu W
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, 100050 Beijing, China.
Zhou H
Department of Neurosurgery, The First People Hospital of Lianyungang, Tongguan Beilu 182, 222002 Lianyungan, Jiangsu, China.
Neidert MC
Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091 Zurich, Switzerland.
Schmid C
Division of Endocrinology and Diabetes, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
Bernays RL
Neurochirurgie Klinik Hirslanden, Witellikerstrasse 40, CH-8032 Zurich, Switzerland.
Ni M
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, 100050 Beijing, China.
Zhou D
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, 100050 Beijing, China.
Jia W
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, 100050 Beijing, China.
Jia G
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, 100050 Beijing, China. Electronic address: jiaguijun@cssc.net.cn.

MeSH

AdenomaAdolescentAdultComorbidityEmpty Sella SyndromeFemaleGrowth Hormone-Secreting Pituitary AdenomaHumansMaleMiddle AgedYoung Adult

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25194306

Citation

Liu, Weiming, et al. "Growth Hormone Secreting Pituitary Microadenomas and Empty Sella - an Under-recognized Association?" Clinical Neurology and Neurosurgery, vol. 126, 2014, pp. 18-23.
Liu W, Zhou H, Neidert MC, et al. Growth hormone secreting pituitary microadenomas and empty sella - An under-recognized association? Clin Neurol Neurosurg. 2014;126:18-23.
Liu, W., Zhou, H., Neidert, M. C., Schmid, C., Bernays, R. L., Ni, M., Zhou, D., Jia, W., & Jia, G. (2014). Growth hormone secreting pituitary microadenomas and empty sella - An under-recognized association? Clinical Neurology and Neurosurgery, 126, 18-23. https://doi.org/10.1016/j.clineuro.2014.08.012
Liu W, et al. Growth Hormone Secreting Pituitary Microadenomas and Empty Sella - an Under-recognized Association. Clin Neurol Neurosurg. 2014;126:18-23. PubMed PMID: 25194306.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Growth hormone secreting pituitary microadenomas and empty sella - An under-recognized association? AU - Liu,Weiming, AU - Zhou,Hui, AU - Neidert,Marian Christoph, AU - Schmid,Christoph, AU - Bernays,René-Ludwig, AU - Ni,Ming, AU - Zhou,Dabiao, AU - Jia,Wang, AU - Jia,Guijun, Y1 - 2014/08/17/ PY - 2014/07/03/received PY - 2014/08/08/revised PY - 2014/08/09/accepted PY - 2014/9/8/entrez PY - 2014/9/10/pubmed PY - 2015/8/20/medline KW - Empty sella KW - Growth hormone (GH) KW - Microadenomas KW - Neuroimaging KW - Transsphenoidal approach SP - 18 EP - 23 JF - Clinical neurology and neurosurgery JO - Clin Neurol Neurosurg VL - 126 N2 - 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. SN - 1872-6968 UR - https://www.unboundmedicine.com/medline/citation/25194306/Growth_hormone_secreting_pituitary_microadenomas_and_empty_sella___An_under_recognized_association DB - PRIME DP - Unbound Medicine ER -