Pituitary Volume Research Articles

Pituitary gland volumes in children with normal endocrine function.

Magnetic resonance imaging (MRI) is often the first modality of choice in the detection of pituitary pathologies due to its excellent contrast resolution and high spatial resolution. However, evaluating the size of the pituitary gland is somewhat difficult since the gland morphology varies widely among individuals. The aim of this study was to provide normal reference values for pituitary volumes in the pediatric population using three-dimensional (3-D) MRI data. We also aimed to compare the volumetric data measured through 3-D images with the mathematical volumes obtained by the ellipsoid formula from 2-D images, considering the demographic subgroups of age and sex. This study was performed retrospectively using PACS-archived brain MRIs obtained in the Pediatric Radiology Unit. Eight hundred children under the age of 18 who underwent brain MRI between January 2014 and May 2018 for headaches, seizures or trauma and who had no brain anomaly or endocrine pathology were recruited. Pituitary volumes were separately calculated from those brain MRIs by means of ellipsoid formula and volumetry. The mean, standard deviation, maximum and minimum and median values were achieved for each 1-year age group in both sexes. Normal reference ranges containing 5th -10th -25th -50th -75th -90th -95th percentiles of volumetric pituitary values were tabulated. Pituitary gland volumes in both sexes were found to increase gradually with age. The average 3-D volume values were greater in girls than boys except for the age groups 1-2years and 8-9years. Pituitary volumes showed a growth spurt during early puberty, which was more prominent in girls. Moreover, a strong positive correlation was noted between the 2-D calculated and 3-D measured volumes in both sexes. Normative data obtained through this study can be used for clinical diagnostic purposes as well as a reference for future research. The 2-D calculated volumes be used where it is not possible to obtain 3-D volumetric values.

Historical and future trends in emergency pituitary referrals: a machine learning analysis

PurposeAcute pituitary referrals to neurosurgical services frequently necessitate emergency care. Yet, a detailed characterisation of pituitary emergency referral patterns, including how they may change prospectively is lacking. This study aims to evaluate historical and current pituitary referral patterns and utilise state-of-the-art machine learning tools to predict future service use.MethodsA data-driven analysis was performed using all available electronic neurosurgical referrals (2014–2021) to the busiest U.K. pituitary centre. Pituitary referrals were characterised and volumes were predicted using an auto-regressive moving average model with a preceding seasonal and trend decomposition using Loess step (STL-ARIMA), compared against a Convolutional Neural Network-Long Short-Term Memory (CNN-LSTM) algorithm, Prophet and two standard baseline forecasting models. Median absolute, and median percentage error scoring metrics with cross-validation were employed to evaluate algorithm performance.Results462 of 36,224 emergency referrals were included (referring centres = 48; mean patient age = 56.7 years, female:male = 0.49:0.51). Emergency medicine and endocrinology accounted for the majority of referrals (67%). The most common presentations were headache (47%) and visual field deficits (32%). Lesions mainly comprised tumours or haemorrhage (85%) and involved the pituitary gland or fossa (70%). The STL-ARIMA pipeline outperformed CNN-LSTM, Prophet and baseline algorithms across scoring metrics, with standard accuracy being achieved for yearly predictions. Referral volumes significantly increased from the start of data collection with future projected increases (p < 0.001) and did not significantly reduce during the COVID-19 pandemic.ConclusionThis work is the first to employ large-scale data and machine learning to describe and predict acute pituitary referral volumes, estimate future service demands, explore the impact of system stressors (e.g. COVID pandemic), and highlight areas for service improvement.

Diagnostic criteria of small sellar lesions with hyperprolactinemia: Prolactinoma or else.

ObjectiveTo evaluate the combined predictive value of MRI criteria with the prolactin-volume-ratio (PVR) to differentiate prolactinoma from non-prolactinoma, in small sellar lesions with hyperprolactinemia.MethodsRetrospective analysis of 55 patients with sellar lesions of ≤15 mm diameter on MRI and hyperprolactinemia of ≤150 ng/mL, surgically treated between 2003 and 2020 at the Medical University of Vienna, with a conclusive histopathological report. Serum prolactin levels, extent of pituitary stalk deviation, size and volume of the lesion were assessed. The PVR was calculated by dividing the preoperative prolactin level by tumor volume.ResultsOur study population consisted of 39 patients (71%) with a prolactin-producing pituitary adenoma (group A), while 16 patients (29%) had another type of sellar lesion (group B). Patients in group A were significantly younger (p=0.012), had significantly higher prolactin levels at diagnosis (p<0.001) as well as smaller tumor volume (p=0.036) and lower degree of pituitary stalk deviation (p=0.009). The median PVR was significantly higher in group A (243 ng/mL per cm3) than in group B (83 ng/mL per cm3; p=0.002). Furthermore, the regression operating characteristics analysis revealed a PVR >100 ng/mL per cm3 to be predictive for distinguishing prolactin-producing lesions from other small sellar lesions.ConclusionIn patients with small sellar lesions, Prolactin-Volume-Ratios >100 represents a possible predictive marker for the diagnosis of prolactin-producing pituitary adenomas.

New Entity-Thalassemic Endocrine Disease: Major Beta-Thalassemia and Endocrine Involvement.

New Entity-Thalassemic Endocrine Disease: Major Beta-Thalassemia and Endocrine Involvement.

An altered state of consciousness while using anticoagulants and the incidental discovery of a pituitary lesion: considering pituitary apoplexy.

SummaryPituitary apoplexy (PA) is a medical emergency with complex diagnosis and management. In this study, we describe a case of PA in a 63-year-old male treated with oral anticoagulant therapy for atrial fibrillation. In the patient, PA manifested itself with asthenia and severe headache not responsive to common analgesics. Despite the finding of a pituitary mass through CT, and in anticipation of the endocrinological evaluation and pituitary MRI, the patient’s clinical condition worsened with an escalation of headache and asthenia associated with deterioration of the visual field and impairment of consciousness level. The emergency assessments revealed an adrenal failure, whereas MRI showed a haemorrhagic pituitary macroadenoma with compression of the optic chiasm. Intravenous fluids repletion and high-dose hydrocortisone were started with a rapid improvement of the patient’s health and visual field abnormalities. Hydrocortisone was gradually reduced to a replacement dose. During the follow-up, panhypopituitarism was documented, and replacement therapies with l-thyroxine and testosterone were introduced. Three months later, a pituitary MRI showed a 50% reduction in the pituitary adenoma volume.Learning pointsPituitary apoplexy (PA) is a medical emergency that can result in haemodynamic instability and abnormalities in the level of consciousness.The management of PA requires a multidisciplinary team that includes endocrinologists, ophthalmologists, neuro-radiologists, and neuro-surgeons.Pituitary MRI with gadolinium is the diagnostic gold standard for PA.PA therapy aims to improve general conditions and treat compression symptoms, especially visual field abnormalities.Adrenocorticotrophic hormone deficiency is a common and severe complication of PA. Thus, all patients with PA must be promptly treated with injective synthetic glucocorticoids (e.g. hydrocortisone 100 mg) and i.v. saline.PA must be taken into consideration in case of sudden headache in patients with a pituitary macroadenoma, especially if other risk factors are recognized.

MRI intensity and pituitary volume predict adult-onset growth hormone deficiency in patients with obesity and overweight: a new potential tool guiding subsequent diagnostic testing

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

P134. Anterior Pituitary Volumes and Stress in Children and Adolescents With Chromosome 22q11.2 Deletion Syndrome

Children with 22q11.2DS have high rates of anxiety and 30% will develop a psychotic disorder by adulthood. The physiological effects of long-term stress and dysregulation of the hypothalamic-pituitary-adrenal cortical (HPA) and/or sympathetic adrenal medullary (SAM) systems may contribute to the etiopathology of mental illness in this population.

Pituitary Volume in Individuals with Social Anxiety Disorder.

There are no volumetric magnetic resonance imaging studies on the pituitary gland in individuals with social anxiety disorder. The present study aimed to investigate pituitary volume in individuals with social anxiety disorder compared to healthy controls due to the correlation between pituitary gland volume and stress response and the hypothalamic-pituitary-adrenal axis and hypothesized that pituitary gland volume would be different in these individuals. In this study, 21 individuals with social anxiety disorder based on fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and 20 healthy controls were included. Both patient and control groups were scanned with a 1.5-Tesla General Electric (GE) Magnetic Resonance Imaging scanner. Pituitary volume was measured with the manual tracing method. The statistical analysis revealed that the mean pituitary gland volume of the individuals with social anxiety disorder was significantly smaller when compared to that of healthy controls, statistically, as presented inTable 1 [594.10±104.56 mm3 for individuals with social anxiety disorder and 818.01±215.25 mm3 for healthy controls] when it was done by using the analysis of covariance controlled for age (F = 12.979, df = 1, P < .001), sex (F = 11.448, df = 1, P < .001), and total brain volume (F = 10.772, df = 1, P < .001), demonstrating that smaller pituitary volume in social anxiety disorder, when compared to healthy subjects, was an important finding independent of age, sex, or total brain volume. We suggest that social anxiety disorder may be associated with smaller pituitary volume, supporting the notion that anxiety itself could reduce the pituitary volume.

Evaluatıon of Pituıtary/Cranial Imagıng Results of Central Puberty Precocıous Cases

The activation of the gonadotropin-releasing hormone (GnRH) pulse generator before the age of 8 years in girls and 9 years in boys results in central precocious puberty (CPP). Previous studies have shown that the height of the pituitary gland in the CPP cases is higher than in the normal children. In this study, ıt was aimed to evaluate the pituitary gland volüme by MRI in CPP children, and explore the intracranial lesions among children with CPP. The study was performed with 50 children (41 girls, 9 boys) who had been diagnosed with CPP. Pituitary MRI was performed in every child after the diagnosis of CPP. Pituitary gland volüme in CPP children was compared with age/sex-matched control subjects. In addition, if available, cranial MRI of patients were evaluated for the presence of additional intracranial abnormalities or space-occupying lesions. The mean chronological age at diagnosis was 7.1 ± 1.0 (2.4-7.9) years in girls and 7.4 ± 1.7 (3.7-8.8) years in boys. CNS imaging showed pathological findings in 17% (7/41) of the girl cases and 55.5% (5/9) of the boy cases. Pituitary volumes of girls aged 6.0-7.9 years and boys aged 8.0-8.9 years were found to be increased compared to the control group. In this study, we found that CNS imaging showed pathological findings in 17% of the girl cases, and 55.5% of the boy cases. Pituitary volumes of girls aged 6.0-7.9 years and boys aged 8.0-8.9 years were found to be increased compared to the control group.

Relationship between Anterior Pituitary Volume and IGF-1 Serum Levels in Soldiers with Mild Traumatic Brain Injury History.

A high mild traumatic brain injury (mTBI) incidence rate exists in military and sport. Hypopituitarism is an mTBI sequela; however, few studies have examined this phenomenon in those with an mTBI history. This cross-sectional study of Special Operations Forces combat soldiers aimed 1) to relate anterior pituitary gland volumes (actual and normalized) to insulin-like growth factor 1 (IGF-1) concentrations, 2) to examine the effect of mTBI history on anterior pituitary gland volumes (actual and normalized) and IGF-1 concentrations, and 3) to measure the odds of demonstrating lower anterior pituitary gland volumes (actual and normalized) or IGF-1 concentrations if self-reporting mTBI history. Anterior pituitary gland volumes were manually segmented from T1-weighted 3D brain MRI sequences; IGF-1 serum concentrations were quantified using commercial enzyme-linked immunosorbent assays. Correlations and linear regression were used to determine the association between IGF-1 serum concentration and anterior pituitary gland volume (n = 74). Independent samples t-tests were used to compare outcomes between mTBI groups and logistic regression models were fit to test the odds of demonstrating IGF-1 concentration or anterior pituitary volume less than sample median based on mTBI group (n = 54). A significant linear relationship between the subjects' anterior pituitary gland volumes and IGF-1 concentrations (r72 = 0.35, P = 0.002) was observed. Soldiers with mTBI history had lower IGF-1 concentrations (P < 0.001) and lower anterior pituitary gland volumes (P = 0.037) and were at greater odds for IGF-1 serum concentrations less than the sample median (odds ratio = 5.73; 95% confidence interval = 1.77-18.55). Anterior pituitary gland volume was associated with IGF-1 serum concentrations. Mild TBI history may be adversely associated with anterior pituitary gland volumes and IGF-1 concentrations. Longitudinal IGF-1 and anterior pituitary gland monitoring may be indicated in those who report one or more mTBI.

Pituitary volume in adolescents with non-suicidal self-injury: Preliminary evidence for alterations in pituitary maturation

BackgroundNon-suicidal self-injury (NSSI), typically observed in the context of various mental disorders, represents a highly prevalent and serious problem among adolescents. Based on studies linking NSSI with stress, alterations in hypothalamic-pituitary-adrenal (HPA) axis functioning have been suggested to contribute to the development and maintenance of this behavior. While research has mainly focused on cortisol - the main hormonal output of this system - to our knowledge, no study has examined pituitary gland volume (PGV) - an alternative approach of assessing HPA axis functionality that is less state-dependent - in adolescents engaging in NSSI. MethodsMagnetic Resonance Imaging (MRI) was performed among n = 35 adolescents (aged 12–17 years) fulfilling the diagnostic criteria for NSSI disorder according to DSM-5 and n = 31 age-matched healthy controls; PGV was obtained by manual tracing. To test for group differences - our primary aim - a hierarchical linear regression model was computed, controlling for several potential confounding variables. Since adolescence reflects a time period for significant brain development - including changes in PGV - we also tested for an age-dependent group effect. In a second step, we aimed to investigate whether differences in PGV are accounted for by the experience of childhood adversity or psychopathology. Finally, following an exploratory approach, the dimensional association between PGV and various clinical characteristics (e.g., frequency of NSSI) were explored. ResultsNo evidence was found for overall volumetric differences between healthy control participants and adolescents engaging in NSSI (p > 0.05) - recognizing that small effect size differences could not be detected in the present study - but group membership significantly interacted with age in predicting PGV (p = 0.02). Particularly, while PGV increased linearly with age in healthy controls (B = 61.39, SE = 14.94, p < 0.01), no corresponding association was found in NSSI patients (B = 16.83, SE = 12.20, p = 0.17). PGV was not related to adverse experiences during childhood and none of the clinical characteristics (e.g., frequency of NSSI) significantly correlated with PGV (p > 0.05). ConclusionThese results provide preliminary evidence for alterations in pituitary maturation in adolescents engaging in NSSI, although replication in longitudinal studies with larger samples is warranted.

Volumetric MRI Evaluation of Pituitary Gland in North Indian Subjects with Non-diseased Pituitary: Setting the Standards for Normative Data

Introduction The pituitary gland, also called the master gland, was first described by a Belgian scientist Andreas Vesalius in 1543. Pituitary gland is the engine of normal human physiology and its size and volume changes normally during various physiological stages as well as in various pathological processes, so it becomes imperative to have a normal reference value for a particular population to differentiate the normal and pathological pituitary gland. It is a tiny endocrine gland and is found in sella turcica (meaning Turkish Saddle) of sphenoid. Our study was designed to obtain standardized reference values for the volumes of pituitary gland among North Indian population to analyze the potential diagnostic values of pituitary gland volumetric variation with respect to age and gender. The volume of the pituitary gland was measured using a thin section three dimensional (3D) magnetic resonance imaging (MRI) with a section thickness of 1 mm. Methods The study was conducted between 2018-21 on patients with non-diseased pituitary by performing T1-multiplanar sequence and calculating pituitary volume by using Di chiro &amp; Nelson formula. MRI was performed on a Siemens 3 Tesla MRI scanner unit. High resolution Multiplanar-T1 Weighted images were obtained with following parameters: Slice thickness: 1 mm, Acquisition plane: Sagittal &amp; Coronal TR 1180 MS, TE 4.4 MS, Flip angle: 15 degrees, Matrix size: 256 × 256, FOV: 24 × 24 cm. Volume = 0.52 × Depth in Sagittal Plane × Height in Sagittal Plane × Width in Coronal Plane Results There were 152 patients included in the study. The mean age of participants was 43.50 years. Age group of 20-30 years comprised the maximum number of patient’s .The overall mean pituitary volume was 277.96 mm3 and in males the mean pituitary was 267.74 mm3 while in females the mean volume was 288.74 mm3. The largest pituitary gland volumes were 401.94 mm3 and 369.86 mm3 in females and males respectively in 10–20-year group while 319.18 mm3 and 360.49 mm3 in females and males respectively in 20-30 years age group. Beyond 70 years and children age group less than 10 years showed the smallest pituitary. Mean pituitary depth was 9.40 mm. Mean pituitary width was 8.81 mm.

Reduced pituitary volume with relative T1 shortening correlates with behavior in Prader-Willi syndrome

• Reduced pituitary volumes are found in PWS patients. • Relative T 1 signal intensity is reduced in the pituitary gland in PWS patients. • Neuroendocrine-behavior correlates are potential intrinsic biomarkers for PWS. Prader-Willi syndrome is a complex endocrinological and developmental disorder characterized by hyperphagic, autistic, and obsessive behaviors, which have been considered to primarily originate from hypothalamus-pituitary axis system alterations in the brain. While the pituitary gland has been demonstrated to contribute to behavioral phenotypes associated with neuropeptide, e.g., arginine-vasopressin, the relevant alterations in Prader-Willi syndrome remain unknown. This study aimed to investigate developmental abnormalities in the pituitary gland structures and determine whether the structural abnormalities are associated with behavioral characteristics in Prader-Willi syndrome. In total, 21 Japanese individuals with Prader-Willi syndrome and 31 healthy controls with typical development were included. Compared with the control group, the Prader-Willi syndrome group showed reduced anterior and posterior pituitary volume ratios per total intracranial volume with relative T 1 shortening in an age-associated manner. Moreover, altered volume ratios and signal intensities were negatively correlated with hyperphagia and autistic questionnaire scores but positively correlated with obsessive scores. The findings suggest that structural and functional alterations, in part due to altered hypothalamus-pituitary function, may contribute to the behavior in Prader-Willi syndrome. The imaging-behavior correlates and in vivo neurochemical visualization of the pituitary gland might be potential intrinsic biomarkers for behavioral phenotypes in Prader-Willi syndrome and other neurodevelopmental disorders.

Evaluation of structural variations in the pituitary gland, hormonal status and laboratory markers of the central nervous system functioning in patients with chronic disorders of consciousness

BACKGROUND: Consciousness is the state of being awake and aware of oneself and the environment. The disorders of consciousness result from pathologies that impair awareness. The development of effective comprehensive personalized interventions contributing to the recovery of consciousness in patients with chronic disorders of consciousness is one of the most pressing and challenging tasks in modern rehabilitation.&#x0D; AIM: The aim of this study was to understand structural problems of the pituitary gland, blood levels of gonadotropins and melatonin as well as brain damage markers in the blood and cerebrospinal fluid in patients with chronic disorders of consciousness and to analyze the levels of the above markers among different groups of patients depending on the level of impaired consciousness.&#x0D; MATERIALS AND METHODS: We examined 61 chronic disorders of consciousness patients and identified three groups depending on the level of consciousness including 24 patients with unresponsive wakefulness syndrome, 24 patients with a minus minimally conscious state, and 13 patients with minimally conscious state plus. We performed magnetic resonance imaging of chiasmatic-sellar region and determined blood serum levels of follicle-stimulating and luteinizing hormones and melatonin, as well as urinary level of 6-sulfatoxymelatonin and the content of brain derived neurotrophic factor (BDNF), apoptosis antigen (APO-1), FasL, glutamate, and S100 protein in the blood serum and cerebrospinal fluid.&#x0D; RESULTS: The patients were examined in the age ranging from 15 to 61 years old. Patient groups were homogeneous by the level of consciousness in terms of age and duration of chronic disorders of consciousness by the time of examination. The patients did not differ in the pituitary volume regardless of the level of consciousness. No significant differences were found between the groups with different levels of consciousness when studying the levels of melatonin in the blood serum and its metabolite in the urine. A peak in melatonin secretion was detected at 3 a.m. in 54.5 % of the patients, which can be considered as a favorable prognostic marker for further recovery of consciousness. Hypogonadotropic ovarian failure was found in 34 % of the patients, with normogonadotropic ovarian failure in the remaining patients. Serum APO-1 and BDNF levels were significantly higher in patients with minimally conscious state relative to those with unresponsive wakefulness syndrome. Significantly lower levels of glutamate in the cerebrospinal fluid were detected in women with unresponsive wakefulness syndrome compared to patients with minimally conscious state.&#x0D; CONCLUSIONS: Further in-depth examination and accumulation of data on patients with chronic disorders of consciousness may provide an opportunity to identify highly informative markers for predicting outcomes and to develop new effective approaches to rehabilitation of consciousness in this category of patients.

Anterior Pituitary Volume in Patients with Transfusion Dependent Anemias: Volumetric Approaches and Relation to Pituitary MRI\u2011R2

PurposeAnterior pituitary iron overload and volume shrinkage is common in patients with transfusion-dependent anemia and associated with growth retardation and hypogonadotropic hypogonadism. We investigated the accuracy of different MRI-based pituitary volumetric approaches and the relationship between pituitary volume and MRI-R2, particularly with respect to growth and hypogonadism.MethodsIn 43 patients with transfusion-dependent anemia (12–38 years) and 32 healthy controls (12–72 years), anterior pituitary volume was measured by a sagittal T1 GRE 3D sequence at 1.5T and analyzed by 3D semi-automated threshold volumetry (3D-volumetry). This reference method was compared with planimetric 2D-volumetry, approximate volume calculations, and pituitary height. Using a multiple SE sequence, pituitary iron as MRI-R2 was assessed by fitting proton signal intensities to echo times. Growth and hypogonadism were obtained from height percentile tables and patients’ medical charts. From body surface area and age adjusted anterior pituitary volumes of controls, Z‑scores were calculated for all subjects. Separation of controls and patients with respect to Z and pituitary R2 was performed by bivariate linear discriminant analysis.ResultsTuned 2D volumes showed highest agreement with reference 3D-volumes (bias −4.8%; 95% CI:−8.8%|−0.7%). A linear discriminant equation of Z = −17.8 + 1.45 · R2 revealed optimum threshold sensitivity and specificity of 65% and 100% for discrimination of patients from controls, respectively. Of correctly classified patients 71% and 75% showed hypogonadism and growth retardation, respectively.ConclusionAccurate assessment of anterior pituitary size requires 3D or precise 2D volumetry, with shorter analysis time for the latter. Anterior pituitary volume Z‑scores and R2 allow for the identification of patients at risk of pituitary dysfunction.

Normal prepubertal çocuklarda hipofiz hacminin üç boyutlu MRG ile değerlendirilmesi

Purpose: The aim of the present study is to measure the pituitary volume of the children who are under 12 years of age with normal pituitary function and find the reference interval of the normal pituitary volume in the prepubertal period &#x0D; Materials and Methods: A total 240 healthy children (120 boys- 120 girls) under the age of 12 yr who came our clinic for cranial MRI imaging for various indications within 2 years, were examined. The volume of pituitary gland was measured using a thin-section three dimensional magnetic resonance imaging (MRI) sequences of magnetization-prepared rapid gradient echo imaging with a 1-mm thick reconstructed sagittal images. We also examined the midline sagittal T1-weighted images for the measurement of the pituitary height&#x0D; Results: The pituitary gland volume and height demonstrated increasing trend with the age for both genders in the prepubertal period. Although the pituitary volume in the neonatal period is higher in boys than in girls, it became opposite with the age of 6 yr. The height of the pituitary gland increases gradually-slowly with age; while it was higher in boys in the neonatal period, it was higher in girls at the age of 4 years. The lowest, highest and average values of the volume and height values of pituitary gland were found for each age and gender. The reference values of the pituitary volume values containing 5-10-25-50-75-90-95th percentiles were formed for each age and gender.&#x0D; Conclusion: 3D MRI can be used for direct measurement of pituitary volume in prepubertal children. Measuring of pituitary volume using this 3D technique may permit a more precise assessment of the developing pituitary gland in children.

More than a decade of real-world experience of pegvisomant for acromegaly: ACROSTUDY.

ObjectiveTo report the final long-term safety and efficacy analyses of patients with acromegaly treated with pegvisomant from the ACROSTUDY.DesignGlobal (15 countries), multicentre, non-interventional study (2004–2017).MethodsThe complete ACROSTUDY cohort comprised patients with acromegaly, who were being treated with pegvisomant (PEGV) prior to the study or at enrolment. The main endpoints were long-term safety (comorbidities, adverse events (AEs), pituitary tumour volumes, liver tests) and efficacy (IGF1 changes).ResultsPatients (n = 2221) were treated with PEGV for a median of 9.3 years (range, 0–20.8 years) and followed up for a median of 7.4 years (range, 0–13.9 years). Before PEGV, 96.3% had received other acromegaly treatments (surgery/radiotherapy/medications). Before PEGV treatment, 87.2% of patients reported comorbidities. During ACROSTUDY, 5567 AEs were reported in 56.5% of patients and of these 613 were considered treatment-related (in 16.5% of patients) and led to drug withdrawal in 1.3%. Pituitary imaging showed a tumour size increase in 7.1% of patients; the majority (71.1%) reported no changes. Abnormal AST or ALT liver tests occurred in 3.2% of patients. IGF1 normalization rate improved over time, increasing from 11.4% at PEGV start to 53.7% at year 1, and reaching 75.4% at year 10 with the use of ≥30 mg PEGV/day in an increasing proportion of patients.ConclusionThis comprehensive review of the complete cohort in ACROSTUDY confirmed the overall favourable benefit-to-risk profile and high efficacy of PEGV as mono- and combination therapy in patients with an aggressive course/uncontrolled/active acromegaly requiring long-term medical therapy for control.

Pituitary Volume in Patients with Primary Empty Sella and Clinical Relevance to Pituitary Hormone Secretion: A Retrospective Single Center Study.

Background According to neuroradiological findings, empty sella seems to be deprived of pituitary tissue in sella turcica. Changing size of the pituitary volume is closely related to the occurrence of primary empty sella. The aim of the study is to determine pituitary dysfunction in patients with partial or total primary empty sella and the significance of pituitary volume measurements in these patients.Methods This study was designed retrospectively. 67 patients (55 females, 12 males) diagnosed with primary empty sella syndrome between the years of 2015-2019 were included in the study. Patients were divided into two groups: partial (PES) and total (TES) empty sella by magnetic resonance imaging (MRI). Basal anterior pituitary and its hormones were assessed. We also included 26 healthy control subjects (19 females, 7 males) to compare the differences in pituitary volumes. Volumes were measured by using Osirix Dicom Viewer (Pixmeo SARL, Geneve, Swiss) in 3.0 Tesla scanner MRI.Results82.1% (n=55) of all patients were PES and the others were (n=12) TES. Hypopituitarism, known as one or more pituitary hormones deficiency, was found in 12 patients (17.9%). While 9 of them had total PES, the others had partial PES. Secondary adrenal insufficiency and gonadotropin deficiency were more prevalent in patients with TES. Mean volume measurements of patients with TES, PES and healthy subjects were 0.23±0.17, 0.35±0.15, 0.54±0.17 cm3, respectively. Except for IGF1 values (p=0.026), there was not any significant correlation found between the anterior pituitary hormones and volume measurements.ConclusionAlthough volume measurement has helped in the diagnosis of pituitary empty sella (partial or total), it does not seem to have any significant correlation with pituitary secretory function.

Final Outcome in Growth Hormone–Secreting Adenomas After Combination of Maximal Tumor Resection and Medical Treatment

Gross total resection (GTR) is not always possible in acromegalic patients, especially in patients with invasive growth hormone-secreting adenomas. We analyzed the biochemical remission outcome in relation to extent of tumor resection and effectiveness of medical treatment in cases of remnant tumor. Retrospective analysis was performed of acromegalic patients operated on between 2002 and 2017. Preoperative imaging, tumor invasiveness, extent of resection, and biochemical remission were collected. Patients with tumor remnant not amenable to second surgery began medical treatment. The relationship between pituitary adenoma remnant volume and final biochemical outcome was analyzed. Of 120 acromegalic patients operated on, 82 underwent transsphenoidal microsurgery and 38 underwent endonasal endoscopic approach. GTR was achieved in 72 cases (60%); subtotal resection (STR), 21 (17.5%) cases; and partial resection, 27 (22.5%) cases. There was a nonsignificant higher rate of GTR/STR in patients who underwent endonasal endoscopic approach. However, a significantly higher remission rate (89.45% vs. 67.1%) was achieved in these patients (P < 0.01). Greater tumor volume and invasiveness were associated with a lower remission (P < 0.05). Patients with tumor remnant who achieved biochemical remission with added medical therapy had a significantly smaller tumor volume (P < 0.001). The more aggressive surgical resection is, the greater the chance of attaining final biochemical remission, whether or not GTR is achieved. Medical therapy effectiveness is enhanced in cases with STR. Invasive growth hormone-secreting macroadenomas that are not surgically amenable to total resection are best managed with a combination of safe STR and medical treatment.

Pituitary Iron: Effect on Pituitary Volume and Function in Transfusion Dependent Thalassemia

The association of iron toxicity with vital organ dysfunction has been extensively investigated in transfusion-dependent-thalassemia (TDT). However, pituitary iron load and its effect on function have been infrequently addressed. Growth delay, hypogonadism and infertility resulting from iron-induced pituitary toxicity are still prevalent, impacting clinical care and patients' quality of life. Early recognition and timely intervention can potentially prevent irreversible damage and restore partial function.AimsWe aimed to determine pituitary iron load and anterior pituitary volume by MRI in various age groups of TDT and examine their association with systemic and organ-specific iron measures. Additionally, we attempted to stratify the occurrence of abnormal anterior pituitary function by these MRI findings. Identifying such risk thresholds could assist in establishing timing and effectiveness of treatment intervention.MRI (1.5T) measurements of anterior pituitary iron (R2) and volume (Vol) were compared to normal controls (Noetzli 2011) with resultant Z-scores. Mean annual ferritin was calculated and cardiac and liver iron concentration (LIC) were determined by MRI-T2* and superconducting quantum interference device (SQUID) biosusceptometry, respectively. Pituitary hormones (LH and FSH) and growth hormone (Z scores for IGF-1 and IGF-BP3) were determined.ResultsFifty-three TDT patients (51% females) age 25±8 years, (range 10-45 years) were enrolled. Thirty-three (62%) had a ZR2 value >2 (mean 5.4) indicating iron accumulation above 97.5th percentile. Thirty-two patients (60%) had a Z-score for anterior-volume (ZVOL) of less than -2 (mean -2.8) indicating gland shrinkage below the 2.5th percent. In 23 patients (43%) both ZR2 and ZVOL exceeded these thresholds. ZR2 inversely correlated with ZVOL; r =-0.32, p<0.02. Pituitary iron increased with age and differed between patients <18 yr (n=14) and those 18-45 yr (n=39) with a mean ZR2 at 0.9±0.6 and 4.3±0.5, respectively (p<0.001). Anterior pituitary volume declined in older patients, lagging after the iron accumulation (Figure).LH/FSH values and ZR2 showed inverse correlation: r = -0.27 (p<0.03) and -0.3 (p< 0.006) respectively. ZVOL and LH/FSH demonstrated a positive correlation: r = 0.40, p<0.05 and 0.37, p<0.003, respectively. Z(IGF-BP3) but not Z(IGF-1) had an inverse correlation with ZR2: r = -0.5 (p<0.001).ZR2 > 4 was found to be a significant predictor for gland shrinkage; Zvol < -2 was present in 17/33 patients with a ZR2>4 compared to 3/20 with a ZR2<4 (p<0.009). Receiver operator (ROC) analysis confirmed it with an AUC of 0.68. ZR2 >4 was also predictive of presence of clinically important cardiac (T2* <20ms, AUC=0.92, p<0.001) and hepatic iron (LIC >10mg/gd.w., AUC= 0.74, p<0.005). Mean ferritin significantly correlated with ZR2 (p<0.001) but not with the gland's volume.ConclusionsAnterior pituitary iron assessed by MRI, increases with age and correlates with total body iron burden in TDT, suggesting cumulative iron toxicity. It results in a decrease in gland size and impaired gonadotropin and growth hormone secretion. Pituitary iron exceeding ZR2 >4, appears to be a significant predictor for change in gland size, that also is associated with cardiac and liver iron-overload. Pituitary MRI and the concomitant liver and cardiac iron quantification can identify patients at high-risk for further pituitary damage, suggesting that early intervention can potentially prevent additional decline in hormonal secretion. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.