Al Argan Reem, Ramadhan Abdulaziz, Agnihotram Ramanakumar V, Chankowsky Jeffrey, Rivera Juan
Endocrine Section, Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia.
Division of Endocrinology and Metabolism, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada.
Endocr Connect. 2021 Nov 8;10(11):1445-1454. doi: 10.1530/EC-21-0386.
Hypopituitarism tends to occur in large pituitary adenomas. However, similar tumors could present with strikingly different hormonal deficiencies. In this study, we looked at MRI characteristics in non-functioning pituitary adenomas (NFPA), which could predict secondary adrenal insufficiency (SAI) and central hypothyroidism (CHT). We reviewed the files of patients with NFPA attending our clinic. Tumor size, invasiveness, MR-signal intensity, and gadolinium enhancement in preoperative MRI were recorded along with documented presurgical hypopituitarism profile. Logistic regression was used to predict SAI, CHT, or both (SAI/CHT) based on MRI and demographic parameters. Receiver operating characteristic curves were used to determine their diagnostic utility. One hundred twenty-one patients were included in the study. Older age (P = 0.021), male sex (P = 0.043), stalk deviation (P < 0.0001), contrast enhancement (P = 0.029), and optic chiasma compression (P = 0.012) were associated with SAI/CHT. Adenoma vertical height, largest diameter, and estimated volume were also strongly associated with SAI/CHT (P < 0.0001). These associations remained significant in a multivariate analysis. No tumor smaller than 12 mm in vertical height, 17 mm in largest diameter, or 0.9 cm3 in volume was associated with SAI/CHT. At cut-off ≥18 mm for vertical height, ≥23 mm for largest diameter, and ≥3.2 cm3 the sensitivity was around 90-92% for detecting SAI/CHT. Only vertical height was significantly associated with any one or more pituitary hormonal deficit (P = 0.001). In conclusion, adenoma size, independent of the measurement used, remains the best predictor of SAI/CHT in NFPA. Dynamic testing to rule out SAI is probably indicated in adenomas larger than 18 mm vertical height, 23 mm largest diameter and 3.2 cm3 adenoma volume.
垂体功能减退症往往发生于大型垂体腺瘤。然而，类似的肿瘤可能表现出截然不同的激素缺乏症状。在本研究中，我们观察了无功能性垂体腺瘤（NFPA）的MRI特征，这些特征可预测继发性肾上腺功能不全（SAI）和中枢性甲状腺功能减退症（CHT）。我们回顾了在我们诊所就诊的NFPA患者的病历。记录术前MRI中的肿瘤大小、侵袭性、MR信号强度和钆增强情况以及术前记录的垂体功能减退症概况。基于MRI和人口统计学参数，采用逻辑回归来预测SAI、CHT或两者（SAI/CHT）。使用受试者工作特征曲线来确定其诊断效用。121名患者纳入研究。年龄较大（P = 0.021）、男性（P = 0.043）、垂体柄偏移（P < 0.0001）、对比增强（P = 0.029）和视交叉受压（P = 0.012）与SAI/CHT相关。腺瘤垂直高度、最大直径和估计体积也与SAI/CHT密切相关（P < 0.0001）。在多变量分析中，这些关联仍然显著。垂直高度小于12 mm、最大直径小于17 mm或体积小于0.9 cm³的肿瘤与SAI/CHT无关。垂直高度≥18 mm、最大直径≥23 mm和≥3.2 cm³时，检测SAI/CHT的敏感性约为90 - 92%。只有垂直高度与任何一种或多种垂体激素缺乏显著相关（P = 0.001）。总之，腺瘤大小，无论采用何种测量方法，仍然是NFPA中SAI/CHT的最佳预测指标。对于垂直高度大于18 mm、最大直径大于23 mm和腺瘤体积为3.2 cm³的腺瘤，可能需要进行动态检测以排除SAI。
