Growth Hormone-Secreting Pituitary Adenoma: Clinical and MR Imaging Findings

Park, Hong Suk; Chang, Kee Hyun; Han, Moon Hee; Sim, Jung Suk; Lee, Sang Hyun; Song, Jae Uoo; Yoo, In Kyu; Jung, Hee Won; Yeon, Kyung Mo

Abstract

PURPOSE
To describe clinical and MRI findings of growth hormone-secreting pituitary adenoma, to determine ifthere are any characteristic MRI findings different from those of other pituitary adenomas, to evaluate the relationship between tumor size and serum growth hormone level, and to assess the results of immunohistochemical study.
MATERIALS AND METHODS
We retrospectively analysed clinical and MRI findings of 29 patients with growth hormone-secreting pituitary adenoma confirmed by serum growth hormone level and surgery. We also evaluated the relationship between the tumor volume and serum growth hormone level, and the results of immunohistochemical study. Coronal and sagittal T1-weighted MR images in all patients and gadolinium enhanced T1-weighted MR images in28 patients were obtained with 2.0 T(24 cases) and 0.5 T(5 cases) MR imagers. The images were analyzed in terms oftumor size, signal intensity, degree of contrast enhancement, extent of tumor growth and the presence or absenceof cystic change, hemorrhage and calcification.
RESULTS
Clinical manifestations included facial feature changeand soft tissue swelling of hands and feet(n=29), headache(n=12), impaired visual acuity(n=9), symptoms of hyperprolactinemia(n=8), visual field defect(n=5), and others(n=6). On MR images, all of the 29 cases were seen tobe macroadenomas and the size of the tumors averaged 2.2cm(1-5.2 cm). Supra- and infrasellar extensions were seenin 21 and 22 patients, respectively. Cavernous sinus invasion was noted in seven, and in one this was bilateral.Signal intensity was isointense with cortical grey matter in 26 cases(90%). Cystic change or necrosis was seen ineight cases(28%), hemorrhage in four(14%), and calcification in two(7%). After enhancement, most(25/28) of the tumors enhaned less than mormal pituitary in degree. There was no correlation between serum growth hormone level and tumor size. Immunohistochemical study showed positive growth hormone-secreting cells in only 69%(11/16).
CONCLUSION
Clinical findings in patients with growth hormone-secreting pituitary adenomas were various and included acromegaly, headache, visual impairment, and symptoms of hyperprolactinemia, for example. On T1-weightedMR images, all tumor were macroadenoma, and there were no characteristic findings different from those of other pituitary tumors. The volume of a tumor did not correlate with serum hormone level. Immunohistochemical study showed positive growth hormone-secreting cells in a limited number of cases.