Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Mar 28, 2025; 17(3): 100168
Published online Mar 28, 2025. doi: 10.4329/wjr.v17.i3.100168
Evaluation of pituitary tumor volume as a prognostic factor in acromegaly: A cross-sectional study in two centers
Mauricio Alvarez, Angel Donato, Juliana Rincon, Oswaldo Rincon, Natalia Lancheros, Pedro Mancera, Isaac Guzman
Mauricio Alvarez, Oswaldo Rincon, Isaac Guzman, Department of Endocrinology, Hospital Militar Central, Bogota 110221, Distrito Capital de Bogotá, Colombia
Angel Donato, Department of Neuroradiology, Hospital Militar Central, Bogota 110221, Distrito Capital de Bogotá, Colombia
Juliana Rincon, Department of Epidemiology, Fundación Universitaria Sanitas, Bogota 110221, Distrito Capital de Bogotá, Colombia
Natalia Lancheros, Department of Clinical Medicine, Centros Médicos Colsanitas, Bogota 110221, Distrito Capital de Bogotá, Colombia
Pedro Mancera, Department of Endocrinology, Universidad Militar Nueva Granada, Bogota 110221, Distrito Capital de Bogotá, Colombia
Author contributions: Alvarez M was responsible for the conceptualization, study design, patient recruitment, data analysis, and manuscript preparation; Donato A was responsible for the conceptualization, study design, patient recruitment, data analysis, and manuscript preparation; Rincon J was responsible for the data analysis and manuscript writing; Rincon O was responsible for the conceptualization, study design, patient recruitment, data analysis, and manuscript preparation; Guzman I was responsible for patient recruitment, data analysis, and manuscript writing; Lancheros N was responsible for patient recruitment, data analysis, and manuscript writing; Mancera P was responsible for the conceptualization, study design, patient recruitment, data analysis, and manuscript preparation.
Institutional review board statement: The study was approved by the Hospital Militar Central and Unisanitas Ethical Committee through the following act number CEIFUS 3677-22.
Informed consent statement: This study was conducted in accordance with the ethical standards of the institutional review board and the Declaration of Helsinki. Given the retrospective and descriptive nature of the study, individual informed consent was not required, as no identifiable patient data were included in the analysis. The institutional review board approved the waiver of informed consent.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request. Access to data will be provided following a formal request outlining the intended use of the data and subject to ethical approval and data protection regulations.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mauricio Alvarez, MD, Chief Physician, Department of Endocrinology, Hospital Militar Central, Carrera 7a n 94 a 47, Bogota 110221, Distrito Capital de Bogotá, Colombia. mauricioalvarez613@gmail.com
Received: August 8, 2024
Revised: January 14, 2025
Accepted: February 14, 2025
Published online: March 28, 2025
Processing time: 230 Days and 11.5 Hours
Abstract
BACKGROUND

Acromegaly is caused by a pituitary neuroendocrine tumor (PitNET) with excessive production of growth hormone (GH), leading to multisystem complications. Previous studies have identified predictors of disease persistence following surgery and poor response to medical treatment, including tumor size, vertical and horizontal extensions of the adenoma, hyperintensity in T2-weighted magnetic resonance imaging, granulation density, and pre- and postoperative GH and insulin-like growth factor 1 (IGF-1) levels.

AIM

To evaluate PitNET volume as a complementary prognostic factor in patients with acromegaly.

METHODS

This is a retrospective descriptive study with an analytical component evaluating the correlation between the volumetric analysis of GH-producing PitNETs, IGF-1 levels before and after surgery, disease control during follow-up, and the line of therapy required for disease control in a cohort of patients treated at two centers: Endocrinology Department of the Central Military Hospital and Centros Médicos Colsanitas, Bogotá, Colombia.

RESULTS

A total of 77 patients with acromegaly (42 men, 35 women) were included in this study. The mean age at diagnosis was 42 years (SD: 12), with a mean disease duration of 9.9 years (SD: 7.2). The mean pituitary tumor volume was 4358 mm³ (SD: 6291, interquartile range [IQR]: 13602). Patients with controlled acromegaly had a mean PitNET volume of 3202 mm³ (SD: 4845, 95%CI: 621-5784) compared to 5513 mm³ (SD: 7447, 95%CI: 1545-9482) in the uncontrolled group (P = 0.15). A PitNET volume exceeding 3697 mm³ was associated with a higher likelihood of requiring third or fourth-line therapy (50% vs 36%; P = 0.03).

CONCLUSION

PitNET volume was associated with the need for higher-line therapy to manage acromegaly but did not correlate with long-term disease control or with pre- or postsurgical IGF-1 levels. Nevertheless, a trend towards an inverse relationship between tumor volume and future disease control was observed. While macroadenoma classification remains crucial, among patients with macroadenomas, those with a volume exceeding 3697 mm³ could have worse prognosis.

Keywords: Pituitary adenoma; Acromegaly; Somatomedins; Growth hormone; Sella turcica; Magnetic resonance imaging

Core Tip: Acromegaly is caused by a pituitary neuroendocrine tumor (PitNET) with excessive growth hormone (GH) production, leading to multisystem complications. Previous studies have identified predictors of poor prognosis, including tumor size, extensions, T2-weighted magnetic resonance imaging hyperintensity, granulation density, and GH/insulin-like growth factor 1 levels. In this study, PitNET volume was associated with the need for higher-line therapy and showed a trend toward larger volumes in uncontrolled patients, suggesting that adenoma volume could be an additional prognostic factor in acromegaly.