Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec 30;15(1):267.
doi: 10.3390/cancers15010267.

The Prognostic-Based Approach in Growth Hormone-Secreting Pituitary Neuroendocrine Tumors (PitNET): Tertiary Reference Center, Single Senior Surgeon, and Long-Term Follow-Up

Abel Ferrés  1 , Luís Reyes  1 , Alberto Di Somma  1   2 , Thomaz Topczewski  1 , Alejandra Mosteiro  1 , Giulia Guizzardi  1 , Andrea De Rosa  3 , Irene Halperin  2   4 , Felicia Hanzu  2   4 , Mireia Mora  2   4 , Isam Alobid  2   5 , Iban Aldecoa  2   6 , Núria Bargalló  2   7 , Joaquim Enseñat  1   2
Affiliations

The Prognostic-Based Approach in Growth Hormone-Secreting Pituitary Neuroendocrine Tumors (PitNET): Tertiary Reference Center, Single Senior Surgeon, and Long-Term Follow-Up

Abel Ferrés et al. Cancers (Basel). .

Abstract

Postoperative deserved outcomes in acromegalic patients are to normalize serum insulin-like growth factor (IGF-1), reduce the tumoral mass effect, improve systemic comorbidities, and reverse metabolic alterations. Pituitary neuroendocrine tumors (PitNET) are characterized to present a heterogeneous behavior, and growth hormone (GH)-secreting PitNET is not an exception. Promptly determining which patients are affected by more aggressive tumors is essential to guide the optimal postoperative decision-making process [prognostic-based approach]. From 2006 to 2019, 394 patients affected by PitNET were intervened via endoscopic endonasal transsphenoidal approach by the same senior surgeon. A total of 44 patients that met the criteria to be diagnosed as acromegalic and were followed up at least for 24 months (median of 66 months (26-156) were included in the present study. Multiple predictive variables [age, gender, preoperative GH and IGF-1 levels, maximal tumor diameter, Hardy's and Knosp's grade, MRI. T2-weighted tumor intensity, cytokeratin expression pattern, and clinicopathological classification] were evaluated through uni- and multivariate statistical analysis. Sparse probability of long-term remission was related to younger age, higher preoperative GH and- or IGF-1, group 2b of the clinicopathological classification, and sparsely granulated cytokeratin expression pattern. Augmented recurrence risk was related to elevated preoperative GH levels, tumor MRI T2-weighted hyperintensity, and sparsely granulated cytokeratin expression pattern. Finally, elevated risk for reintervention was related to group 2b of the clinicopathological classification, Knosp's grade IV, and tumor MRI T2-weighted hyperintensity. In this study, the authors determined younger age, higher preoperative GH and- or IGF-1 levels, group 2b of the clinicopathological classification, Knosp's grade IV, MRI T2-weighted tumor hyperintensity and sparsely granulated cytokeratin expression pattern are related to worse postoperative outcomes in long-term follow-up patients affected with GH-secreting PitNET.

Keywords: acromegaly; endoscopic endonasal approach; long-term follow-up; pituitary gland; pituitary neuroendoendocrine tumor; prognostic factors.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted without any commercial or financial relationships construed as potential conflict of interest.

Figures

Figure 1
Figure 1
Examples of GH PitNET T2-weighted M.R.I. intensity classification. From left to right: Hypointense, isointense, and hyperintense.
Figure 2
Figure 2
Inclusion criteria flow-chart. PitNET: Pituitary neuroendocrine tumors. EEA: Endoscopic endonasal approach.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Katznelson L., Laws E.R., Melmed S., Molitch M.E., Murad M.H., Utz A., Wass J.A.H. Acromegaly: An Endocrine Society Clinical Practice Guideline. J. Clin. Endocrinol. Metab. 2014;99:3933–3951. doi: 10.1210/jc.2014-2700. - DOI - PubMed
    1. Melmed S. Acromegaly Pathogenesis and Treatment. J. Clin. Investig. 2009;119:3189–3202. doi: 10.1172/JCI39375. - DOI - PMC - PubMed
    1. Abosch A., Tyrrell J.B., Lamborn K.R., Hannegan L.T., Applebury C.B., Wilson C.B. Transsphenoidal Microsurgery for Growth Hormone-Secreting Pituitary Adenomas: Initial Outcome and Long-Term Results. J. Clin. Endocrinol. Metab. 1998;83:3411–3418. doi: 10.1210/jcem.83.10.5111. - DOI - PubMed
    1. Swearingen B., Barker F.G., Katznelson L., Miller B.M., Grinspoon S., Klibanski A., Moayeri N., Black P.M., Zervas N.T. Long-Term Mortality after Transsphenoidal Surgery and Adjunctive Therapy for Acromegaly. J. Clin. Endocrinol. Metab. 1998;83:3419–3426. doi: 10.1210/jc.83.10.3419. - DOI - PubMed
    1. Taghvaei M., Sadrehosseini S.M., Ardakani J.B., Nakhjavani M., Zeinalizadeh M. Endoscopic Endonasal Approach to the Growth Hormone–Secreting Pituitary Adenomas: Endocrinologic Outcome in 68 Patients. World Neurosurg. 2018;117:e259–e268. doi: 10.1016/j.wneu.2018.06.009. - DOI - PubMed

LinkOut - more resources