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64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

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A surgical series on the association of GH-secreting pituitary microadenomas and empty sella

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  • Weiming Liu - Departmant of Neurosurgery, Beijing Tiantan Hospital, Captial Medical University, Beijing, China; Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  • Hui Zhou - Departmant of Neurosurgery, Beijing Tiantan Hospital, Captial Medical University, Beijing, China
  • Marian C. Neidert - Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
  • Rene Bernays - Neurochirurgie Klinik Hirslanden, Zurich, Switzerland
  • Ming Ni - Departmant of Neurosurgery, Beijing Tiantan Hospital, Captial Medical University, Beijing, China
  • Wang Jia - Departmant of Neurosurgery, Beijing Tiantan Hospital, Captial Medical University, Beijing, China
  • Shusen Guan - Departmant of Neurosurgery, Beijing Tiantan Hospital, Captial Medical University, Beijing, China
  • Dabiao Zhou - Departmant of Neurosurgery, Beijing Tiantan Hospital, Captial Medical University, Beijing, China
  • Guijun Jia - Departmant of Neurosurgery, Beijing Tiantan Hospital, Captial Medical University, Beijing, China

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocP 014

doi: 10.3205/13dgnc435, urn:nbn:de:0183-13dgnc4356

Published: May 21, 2013

© 2013 Liu et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The association of growth hormone (GH) secreting pituitary microadenomas and empty sella (ES) has been described in case reports – the underlying mechanisms are unclear. We present 14 such cases, review the literature and discuss the clinical management.

Method: We retrospectively analyzed all patients operated for GH-producing pituitary adenomas in our neurosurgical center between February 2004 and February 2009. Patients with preoperative neuroradiological evidence of ES were included in this study. Magnetic resonance imaging (MRI), computed tomography (CT) imaging, and pituitary function testing were performed. All cases underwent transsphenoidal surgery (TSS). Mean follow-up was 38 months (range 12–80 months).

Results: Out of 152 patients with acromegaly due to GH-producing pituitary adenomas we found fourteen cases (9%) with presurgical evidence of empty sella. All 14 lesions were microadenomas – 10 female (71%) patients and 4 males (29%) (female: male= 2.5:1). Mean age was 42.2 years (range 23–58 years). Mean basal serum GH concentration prior to treatment was 17.0 ± 10.8μg/l; IGF-1 levels were elevated in all cases. With MRI and CT imaging, no ectopic adenomas cases were found. Postoperatively, 13 cases (93%) were cured and 1 case required further stereotactic radiotherapy. One case of new-onset hypopituitarism was observed; no CSF leaks or other complications happened.

Conclusions: The combination of GH-producing microadenomas and empty sella is not rare. In this setting, preoperative CT scans are very useful and the transsphenoidal approach is efficient and safe. The underlying mechanism of the association of GH-producing microadenomas and empty sella needs further studies.