Abstract
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.
Highlights
Pituitary adenomas (PA) are frequent intracranial neoplasms (1, 2)
Diagnosis of nonfunctioning pituitary adenomas (NFPA) was based on the confirmation of adenoma by MRI defined as: (i) Microadenoma which is an adenoma
We found that older age, male sex, and MRI findings of optic chiasma compression, pituitary stalk deviation, and adenoma enhancement post-gadolinium were predictive of these hormonal deficiencies
Summary
Pituitary adenomas (PA) are frequent intracranial neoplasms (1, 2). About half of these tumors are nonfunctioning pituitary adenomas (NFPA), meaning that they do not secrete a hormonal product capable of causing a clinical syndrome (3, 4, 5). They may, cause pituitary hormonal deficits (hypopituitarism) which are associated with increased morbidity and mortality (6, 7). Making a timely diagnosis of hypopituitarism is very important. Pituitary adenomas have been historically classified as microadenomas (1 cm) according to their largest diameters (1).
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