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Growth hormone secreting pituitary adenomas show distinct extrasellar extension patterns compared to nonfunctional pituitary adenomas

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Abstract

Purpose

Patterns of extension of pituitary adenomas (PA) may vary according to PA subtype. Understanding extrasellar extension patterns in growth hormone PAs (GHPA) vis-a-vis nonfunctional PAs (NFPAs) may provide insights into the biology of GHPA and future treatment avenues.

Methods

Preoperative MR imaging (MRI) in 179 consecutive patients treated surgically for NFPA (n = 139) and GHPA (n = 40) were analyzed to determine patterns of extrasellar growth. Extension was divided into two principal directions: cranio-caudal (measured by infrasellar/suprasellar extension), and lateral cavernous sinus invasion (CSI) determined by Knosp grading score of 3–4. Suprasellar extension was defined as tumor extension superior to the tuberculum sellae- dorsum sellae line, and inferior extension as invasion through the sellar floor into the sphenoid sinus or clivus. Categorical analysis was performed using Fisher’s exact test.

Results

GHPAs were overall more likely to remain purely intrasellar compared to NFPA (50% vs 26%, p < 0.001). GHPAs, however, were 7 times more likely to exhibit isolated infrasellar extension compared to NFPA (20% vs 2.8%, p = 0.001). Conversely, NFPAs were twice as likely to exhibit isolated suprasellar extension compared to GHPA (60% vs 28%, p < 0.001), as well as combined suprasellar/infrasellar extension (25% vs 3%, p = 0.011). There were no overall differences in CSI between the two subgroups.

Discussion

GHPA and NFPA demonstrate distinct extrasellar extension patterns on MRI. GHPAs show proclivity for inferior extension with bony invasion, whereas NFPAs are more likely to exhibit suprasellar extension through the diaphragmatic aperture. These distinctions may have implications into the biology and future treatment of PAs.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

The authors have no relevant sources funding, or financial disclosures.

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Authors and Affiliations

  1. USC Brain Tumor Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Dhiraj J. Pangal, Danielle Wishart, Mark S. Shiroishi, Jacob Ruzevick, John D. Carmichael & Gabriel Zada

  2. Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Dhiraj J. Pangal, Danielle Wishart, Jacob Ruzevick & Gabriel Zada

  3. Division of Neuroradiology, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Mark S. Shiroishi

  4. Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    John D. Carmichael

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  1. Dhiraj J. Pangal
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Correspondence to Dhiraj J. Pangal.

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The authors have no potential conflicts of interest to disclose. The study was approved by the IRB at our institution, and patient consent was waived given the retrospective and anonymized nature of the data analysis.

Research involving human participants, their data or biological material

This study was approved by the institutional review board of the University of Southern California and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Pangal, D.J., Wishart, D., Shiroishi, M.S. et al. Growth hormone secreting pituitary adenomas show distinct extrasellar extension patterns compared to nonfunctional pituitary adenomas. Pituitary 25, 480–485 (2022). https://doi.org/10.1007/s11102-022-01217-z

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