Investigation of the Relationship between Adenoma Volume and Perioperative Hormone Levels in Patients with Acromegaly

Abstract

Objective: Current pituitary adenomas classifications and surgical treatment results are made only with two-dimensional radiological sections and hormonal measurements. This study investigated the relationship between hormone levels and volumetric tumor burden by measuring tumor volumes before and after surgery in patients with acromegaly. Methods: In a retrospective clinical study, clinical and radiologically measured volumetric, hormonal and surgical results of 52 patients who were operated on with the diagnosis of acromegaly due to pituitary adenoma were examined. Radiological measurements were obtained using the ImageJ software package version 1.47 and the measure-stack plug-in. In statistical analysis, the relationship between tumor volumes, growth horomone (GH) and insulin-like growth factor (IGF-I) levels was analyzed during and after surgery. Results: Of the 52 cases, 22 (42.3%) were male, 30 (57.7%) were female, and the mean age of the patients was 43.40±11.40 years. 45 cases (86.53%) were macroadenoma, 7 cases (13.47%) were microadenoma. All patients were operated by the transnasal-transseptal-transsphenoidal route. When the early preoperative and postoperative hormone results of the patients were compared, significant decreases were observed in GH (82.1%), volume (67%), and IGF-1 (50%) levels in the postoperative period. While there was a significant positive correlation between preoperative GH levels and tumor volumes (r: 0.516, p<0.05), there was also a significant positive correlation between postoperative GH levels and tumor volumes (r: 0.755, p<0.05). No correlation was observed between IGF-I levels and volume in the preoperative and postoperative period (r:-0.051, p>0.05) (r:0.259, p>0.05). A significant positive correlation was found between postoperative GH levels and IGF-1 levels (r: 0.303, p<0.05). Conclusion: Both GH and IGF-I levels increase significantly as tumor volume increases in patients with pituitary adenoma before and after surgical treatment. Volumetric measurements may be necessary for classifying patients with acromegaly before and after surgery and in the more objective and quantitative determination of postoperative residual and/or recurrence. For this reason, we believe that it is more accurate to evaluate tumor tissues occupying a 3-dimensional volume with volumetric measurements.