PNA Medical Corner: Growth of Pituitary Adenomas
This month the PNA Medical Corner highlights and article co-authored by Dr. Shereen Ezzat, a member of the PNA's Scientific Advisory Panel. The article looks at the growth patterns in pituitary tumors.
Growth patterns of pituitary adenomas and histopathological correlates.
Monsalves E, Larjani S, Loyola Godoy B, Juraschka K, Carvalho F, Kucharczyk W, Kulkarni A, Mete O, Gentili F, Ezzat S, Zadeh G.
J Clin Endocrinol Metab. 2014 Jan 1:jc20133054. [Epub ahead of print]
Institute of Medical Science, University of Toronto, Toronto, Canada.
Context: The factors associated with pituitary adenoma (PA) growth rate remain unclear. Objective: To establish whether the preoperative growth and extension pattern of PA can predict postoperative growth rate and recurrence in addition to whether PA growth rate correlates with proliferation and growth factor expression Patients: 153 consecutive patients who underwent surgery for pituitary adenoma from 1999-2011 at Toronto Western Hospital were identified. Main Outcome measures: PA growth rate was measured both pre- and postoperatively and its association to patient demographics, MRI and histolopathological parameters was determined. Results: The preoperative growth rate was associated with age (p=0.0001), suprasellar growth(p=0.003), the presence of a cyst/hemorrhage(p=0.004), the MIB-1(p=0.005), FGFR4 positivity (p=0.047), and p27 negativity (p=0.007). Following surgery, there were 34.6% residual volumes, which were associated with older age (p=0.038) and also with growth patterns including anterior, posterior, suprasellar, and CS extension(p=.001). 41.6% of these residual grew and postoperative growth rate was calculated. Pre- and postoperative growth rates were correlated (r= 0.497, p=0.026). Postoperative growth rate was associated with age (p=0.015) and gender (p=0.017). Conclusions: Our data suggest that the growth rate of PAs are influenced by various patient and tumor-specific characteristics including the age and sex of the patient, the specific subtype of PA, it's hormonal activity, it's immunohistochemical profile including the MIB-1 LI status, and it's preponderance for different growth directions relative to the pituitary fossa. Furthermore, the pre- and postoperative PA growth rates were correlated suggesting that postoperative PA growth rates can be predicted, in part, by preoperative growth rates thus better informing postoperative outcome.