Baseline MRI findings as predictors of hypopituitarism in patients with non-functioning pituitary adenomas

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) a...

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Autores principales:	Reem Al Argan, Abdulaziz Ramadhan, Ramanakumar V Agnihotram, Jeffrey Chankowsky, Juan Rivera
Formato:	article
Lenguaje:	EN
Publicado:	Bioscientifica 2021
Materias:	non-functioning pituitary adenoma hypopituitarism pituitary mri secondary adrenal insufficiency central hypothyroidism Diseases of the endocrine glands. Clinical endocrinology RC648-665
Acceso en línea:	https://doi.org/10.1530/EC-21-0386 https://doaj.org/article/8b119fe877c34a8192c80661708875d1
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spelling	oai:doaj.org-article:8b119fe877c34a8192c80661708875d12021-11-10T12:32:41ZBaseline MRI findings as predictors of hypopituitarism in patients with non-functioning pituitary adenomashttps://doi.org/10.1530/EC-21-03862049-3614https://doaj.org/article/8b119fe877c34a8192c80661708875d12021-11-01T00:00:00Zhttps://ec.bioscientifica.com/view/journals/ec/10/11/EC-21-0386.xmlhttps://doaj.org/toc/2049-3614Hypopituitarism 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, l argest 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 verti cal 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 in dicated in adenomas larger than 18 mm vertical height, 23 mm largest diameter and 3.2 cm3 adenoma volume.Reem Al ArganAbdulaziz RamadhanRamanakumar V AgnihotramJeffrey ChankowskyJuan RiveraBioscientificaarticlenon-functioning pituitary adenomahypopituitarismpituitary mrisecondary adrenal insufficiencycentral hypothyroidismDiseases of the endocrine glands. Clinical endocrinologyRC648-665ENEndocrine Connections, Vol 10, Iss 11, Pp 1445-1454 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	non-functioning pituitary adenoma hypopituitarism pituitary mri secondary adrenal insufficiency central hypothyroidism Diseases of the endocrine glands. Clinical endocrinology RC648-665
spellingShingle	non-functioning pituitary adenoma hypopituitarism pituitary mri secondary adrenal insufficiency central hypothyroidism Diseases of the endocrine glands. Clinical endocrinology RC648-665 Reem Al Argan Abdulaziz Ramadhan Ramanakumar V Agnihotram Jeffrey Chankowsky Juan Rivera Baseline MRI findings as predictors of hypopituitarism in patients with non-functioning pituitary adenomas
description	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, l argest 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 verti cal 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 in dicated in adenomas larger than 18 mm vertical height, 23 mm largest diameter and 3.2 cm3 adenoma volume.
format	article
author	Reem Al Argan Abdulaziz Ramadhan Ramanakumar V Agnihotram Jeffrey Chankowsky Juan Rivera
author_facet	Reem Al Argan Abdulaziz Ramadhan Ramanakumar V Agnihotram Jeffrey Chankowsky Juan Rivera
author_sort	Reem Al Argan
title	Baseline MRI findings as predictors of hypopituitarism in patients with non-functioning pituitary adenomas
title_short	Baseline MRI findings as predictors of hypopituitarism in patients with non-functioning pituitary adenomas
title_full	Baseline MRI findings as predictors of hypopituitarism in patients with non-functioning pituitary adenomas
title_fullStr	Baseline MRI findings as predictors of hypopituitarism in patients with non-functioning pituitary adenomas
title_full_unstemmed	Baseline MRI findings as predictors of hypopituitarism in patients with non-functioning pituitary adenomas
title_sort	baseline mri findings as predictors of hypopituitarism in patients with non-functioning pituitary adenomas
publisher	Bioscientifica
publishDate	2021
url	https://doi.org/10.1530/EC-21-0386 https://doaj.org/article/8b119fe877c34a8192c80661708875d1
work_keys_str_mv	AT reemalargan baselinemrifindingsaspredictorsofhypopituitarisminpatientswithnonfunctioningpituitaryadenomas AT abdulazizramadhan baselinemrifindingsaspredictorsofhypopituitarisminpatientswithnonfunctioningpituitaryadenomas AT ramanakumarvagnihotram baselinemrifindingsaspredictorsofhypopituitarisminpatientswithnonfunctioningpituitaryadenomas AT jeffreychankowsky baselinemrifindingsaspredictorsofhypopituitarisminpatientswithnonfunctioningpituitaryadenomas AT juanrivera baselinemrifindingsaspredictorsofhypopituitarisminpatientswithnonfunctioningpituitaryadenomas
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Baseline MRI findings as predictors of hypopituitarism in patients with non-functioning pituitary adenomas

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