Alvarez Mauricio, Donato Angel, Rincon Juliana, Rincon Oswaldo, Lancheros Natalia, Mancera Pedro, Guzman Isaac
Department of Endocrinology, Hospital Militar Central, Bogota 110221, Distrito Capital de Bogotá, Colombia.
Department of Neuroradiology, Hospital Militar Central, Bogota 110221, Distrito Capital de Bogotá, Colombia.
World J Radiol. 2025 Mar 28;17(3):100168. doi: 10.4329/wjr.v17.i3.100168.
Acromegaly is caused by a pituitary neuroendocrine tumor (PitNET) with excessive production of growth hormone (GH), leading to multisystem complications. Previous studies have identified predictors of disease persistence following surgery and poor response to medical treatment, including tumor size, vertical and horizontal extensions of the adenoma, hyperintensity in T2-weighted magnetic resonance imaging, granulation density, and pre- and postoperative GH and insulin-like growth factor 1 (IGF-1) levels.
To evaluate PitNET volume as a complementary prognostic factor in patients with acromegaly.
This is a retrospective descriptive study with an analytical component evaluating the correlation between the volumetric analysis of GH-producing PitNETs, IGF-1 levels before and after surgery, disease control during follow-up, and the line of therapy required for disease control in a cohort of patients treated at two centers: Endocrinology Department of the Central Military Hospital and Centros Médicos Colsanitas, Bogotá, Colombia.
A total of 77 patients with acromegaly (42 men, 35 women) were included in this study. The mean age at diagnosis was 42 years (SD: 12), with a mean disease duration of 9.9 years (SD: 7.2). The mean pituitary tumor volume was 4358 mm³ (SD: 6291, interquartile range [IQR]: 13602). Patients with controlled acromegaly had a mean PitNET volume of 3202 mm³ (SD: 4845, 95%CI: 621-5784) compared to 5513 mm³ (SD: 7447, 95%CI: 1545-9482) in the uncontrolled group ( = 0.15). A PitNET volume exceeding 3697 mm³ was associated with a higher likelihood of requiring third or fourth-line therapy (50% 36%; = 0.03).
PitNET volume was associated with the need for higher-line therapy to manage acromegaly but did not correlate with long-term disease control or with pre- or postsurgical IGF-1 levels. Nevertheless, a trend towards an inverse relationship between tumor volume and future disease control was observed. While macroadenoma classification remains crucial, among patients with macroadenomas, those with a volume exceeding 3697 mm³ could have worse prognosis.
肢端肥大症由垂体神经内分泌肿瘤（PitNET）引起，该肿瘤过度分泌生长激素（GH），导致多系统并发症。既往研究已确定手术治疗后疾病持续存在及药物治疗反应不佳的预测因素，包括肿瘤大小、腺瘤的垂直和水平延伸、T2加权磁共振成像中的高信号强度、颗粒密度以及术前和术后GH及胰岛素样生长因子1（IGF-1）水平。
评估PitNET体积作为肢端肥大症患者的补充预后因素。
这是一项回顾性描述性研究，包含分析部分，评估在两个中心接受治疗的一组患者中，产生GH的PitNET体积分析、手术前后IGF-1水平、随访期间疾病控制情况以及疾病控制所需治疗方案之间的相关性。这两个中心分别是哥伦比亚波哥大中央军事医院内分泌科和Centros Médicos Colsanitas。
本研究共纳入77例肢端肥大症患者（42例男性，35例女性）。诊断时的平均年龄为42岁（标准差：12），平均病程为9.9年（标准差：7.2）。垂体肿瘤平均体积为4358 mm³（标准差：6291，四分位间距[IQR]：13602）。肢端肥大症得到控制的患者，其PitNET平均体积为3202 mm³（标准差：4845，95%置信区间：621 - 5784），而未得到控制的组为5513 mm³（标准差：7447，95%置信区间：1545 - 9482）（P = 0.15）。PitNET体积超过3697 mm³与需要三线或四线治疗的可能性更高相关（50%对36%；P = 0.03）。
PitNET体积与肢端肥大症管理中需要更高线治疗相关，但与长期疾病控制或术前及术后IGF-1水平无关。然而，观察到肿瘤体积与未来疾病控制之间存在负相关趋势。虽然大腺瘤分类仍然至关重要，但在大腺瘤患者中，体积超过3697 mm³的患者预后可能更差。
