Investigation of the Relationship between Adenoma Volume and Perioperative Hormone Levels in Patients with Acromegaly

Abstract views: 173 / PDF downloads: 57




Pituitary adenoma, Acromegaly, Volume, Transsphenoidal


Objective: Current pituitary adenomas classifications and surgical treatment results are made only with two-dimensional radiological sections and hormonal measurements. This study investigated the relationship between hormone levels and volumetric tumor burden by measuring tumor volumes before and after surgery in patients with acromegaly.

Methods: In a retrospective clinical study, clinical and radiologically measured volumetric, hormonal and surgical results of 52 patients who were operated on with the diagnosis of acromegaly due to pituitary adenoma were examined. Radiological measurements were obtained using the ImageJ software package version 1.47 and the measure-stack plug-in. In statistical analysis, the relationship between tumor volumes, growth horomone (GH) and insulin-like growth factor (IGF-I) levels was analyzed during and after surgery.

Results: Of the 52 cases, 22 (42.3%) were male, 30 (57.7%) were female, and the mean age of the patients was 43.40±11.40 years. 45 cases (86.53%) were macroadenoma, 7 cases (13.47%) were microadenoma. All patients were operated by the transnasal-transseptal-transsphenoidal route. When the early preoperative and postoperative hormone results of the patients were compared, significant decreases were observed in GH (82.1%), volume (67%), and IGF-1 (50%) levels in the postoperative period. While there was a significant positive correlation between preoperative GH levels and tumor volumes (r: 0.516, p<0.05), there was also a significant positive correlation between postoperative GH levels and tumor volumes (r: 0.755, p<0.05). No correlation was observed between IGF-I levels and volume in the preoperative and postoperative period (r:-0.051, p>0.05) (r:0.259, p>0.05). A significant positive correlation was found between postoperative GH levels and IGF-1 levels (r: 0.303, p<0.05).

Conclusion: Both GH and IGF-I levels increase significantly as tumor volume increases in patients with pituitary adenoma before and after surgical treatment. Volumetric measurements may be necessary for classifying patients with acromegaly before and after surgery and in the more objective and quantitative determination of postoperative residual and/or recurrence. For this reason, we believe that it is more accurate to evaluate tumor tissues occupying a 3-dimensional volume with volumetric measurements.


Metrics Loading ...


Ben-Shlomo A, Melmed S (2008) Acromegaly. Endocrinol Metab Clin North Am. 37(1):101-22, viii.

Lugo G, Pena L, Cordido F (2012) Clinical manifestations and diagnosis of acromegaly. Int J Endocrinol. 2012:540398.

Melmed S (2006) Medical progress: Acromegaly. N Engl J Med. 355(24):2558-73.

Freda PU, Reyes CM, Nuruzzaman AT, Sundeen RE, Bruce JN (2003) Basal and glucose-suppressed GH levels less than 1 microg/L in newly diagnosed acromegaly. Pituitary. 6(4):175-80.

Abedelahi A, Hasanzadeh H, Hadizadeh H, Joghataie MT (2013) Morphometric and volumetric study of caudate and putamen nuclei in normal individuals by MRI: Effect of normal aging, gender and hemispheric differences. Pol J Radiol. 78(3):7-14.

Schneider CA, Rasband WS, Eliceiri KW (2012) NIH Image to ImageJ: 25 years of image analysis. Nat Methods. 9(7):671-5.

Abramoff MD, Magelhaes PJ, Ram SJ (2004) Image processing with ImageJ. Biophoton Int. 11:36–42

Lopes MBS (2017) The 2017 World Health Organization classification of tumors of the pituitary gland: a summary. Acta Neuropathol. 134(4):521-535.

Knosp E, Steiner E, Kitz K, Matula C (1993) Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery. 33(4):610-7; discussion 617-8.

Sato A, Teshima T, Ishino H, Harada Y, Yogo T, Kanno N, Hasegawa D, Hara Y (2016) A magnetic resonance imaging-based classification system for indication of trans-sphenoidal hypophysectomy in canine pituitary-dependent hypercortisolism. J Small Anim Pract. 57(5):240-6.

Di Maio S, Biswas A, Vézina JL, Hardy J, Mohr G (2012) Pre- and postoperative magnetic resonance imaging appearance of the normal residual pituitary gland following macroadenoma resection: Clinical implications. Surg Neurol Int. 3:67.

Dello SA, van Dam RM, Slangen JJ, van de Poll MC, Bemelmans MH, Greve JW, Beets-Tan RG, Wigmore SJ, Dejong CH (2007) Liver volumetry plug and play: do it yourself with ImageJ. World J Surg. 31(11):2215-21.

Colao A, Pivonello R, Auriemma RS, De Martino MC, Bidlingmaier M, Briganti F, Tortora F, Burman P, Kourides IA, Strasburger CJ, Lombardi G (2006) Efficacy of 12-month treatment with the GH receptor antagonist pegvisomant in patients with acromegaly resistant to long-term, high-dose somatostatin analog treatment: effect on IGF-I levels, tumor mass, hypertension and glucose tolerance. Eur J Endocrinol. 154(3):467-77.

Di Chiro G, Nelson KB (1962) The volume of the sella turcica. Am J Roentgenol Radium Ther Nucl Med. 87:989-1008

Bazin PL, Cuzzocreo JL, Yassa MA, Gandler W, McAuliffe MJ, Bassett SS, Pham DL (2007) Volumetric neuroimage analysis extensions for the MIPAV software package. J Neurosci Methods. 165(1):111-21.

Egger J, Kapur T, Nimsky C, Kikinis R (2012) Pituitary adenoma volumetry with 3D Slicer. PLoS One. 7(12):e51788.

Mayer KN, Latal B, Knirsch W, Scheer I, von Rhein M, Reich B, Bauer J, Gummel K, Roberts N, Tuura RO (2016) Comparison of automated brain volumetry methods with stereology in children aged 2 to 3 years. Neuroradiology. 58(9):901-10.

Benesch H, Felber SR, Finkenstedt G, Kremser C, Stockhammer G, Aichner FT (1995) MR volumetry for monitoring intramuscular bromocriptine treatment in macroprolactinomas. J Comput Assist Tomogr. 19(6):866-70.

McGrath GA, Goncalves RJ, Udupa JK, Grossman RI, Pavlou SN, Molitch ME, Rivier J, Vale WW, Snyder PJ (1993) New technique for quantitation of pituitary adenoma size: use in evaluating treatment of gonadotroph adenomas with a gonadotropin-releasing hormone antagonist. J Clin Endocrinol Metab. 76(5):1363-8.

Cullen AE, Day FL, Roberts RE, Pariante CM, Laurens KR (2015) Pituitary gland volume and psychosocial stress among children at elevated risk for schizophrenia. Psychol Med. 45(15):3281-92.

Shah JL, Tandon N, Howard ER, Mermon D, Miewald JM, Montrose DM, Keshavan MS (2015) Pituitary volume and clinical trajectory in young relatives at risk for schizophrenia. Psychol Med. 45(13):2813-24.

Kessler M, Tenner M, Frey M, Noto R (2016) Pituitary volume in children with growth hormone deficiency, idiopathic short stature and controls. J Pediatr Endocrinol Metab. 29(10):1195-1200.

Deeb A, Attia S, Elhag G, El Fatih A, Reddy J, Nagelkerke N (2015) Pituitary gland size is a useful marker in diagnosing isolated growth hormone deficiency in short children. J Pediatr Endocrinol Metab. 28(9-10):981-4.

Pieper CC, Teismann IK, Konrad C, Heindel WL, Schiffbauer H (2013) Changes of pituitary gland volume in Kennedy disease. AJNR Am J Neuroradiol. 34(12):2294-7.

Tirosh A, Papadakis GZ, Chittiboina P, Lyssikatos C, Belyavskaya E, Keil M, Lodish MB, Stratakis CA (2017) 3D Volumetric Measurements of GH Secreting Adenomas Correlate with Baseline Pituitary Function, Initial Surgery Success Rate, and Disease Control. Horm Metab Res. 49(6):440-445.

Schwyzer L, Starke RM, Jane JA Jr, Oldfield EH (2015) Percent reduction of growth hormone levels correlates closely with percent resected tumor volume in acromegaly. J Neurosurg. 122(4):798-802.

Oshino S, Saitoh Y, Kasayama S, Arita N, Ohnishi T, Kohara H, Izumoto S, Yoshimine T (2006) Short-term preoperative octreotide treatment of GH-secreting pituitary adenoma: predictors of tumor shrinkage. Endocr J. 53(1):125-32.

Colao A, Auriemma RS, Pivonello R (2016) The effects of somatostatin analogue therapy on pituitary tumor volume in patients with acromegaly. Pituitary. 19(2):210-21.

Giustina A, Mazziotti G, Torri V, Spinello M, Floriani I, Melmed S (2012) Meta-analysis on the effects of octreotide on tumor mass in acromegaly. PLoS One. 7(5):e36411.

Colao A, Auriemma RS, Rebora A, Galdiero M, Resmini E, Minuto F, Lombardi G, Pivonello R, Ferone D (2009) Significant tumour shrinkage after 12 months of lanreotide Autogel-120 mg treatment given first-line in acromegaly. Clin Endocrinol (Oxf). 71(2):237-45.

Mooney MA, Hardesty DA, Sheehy JP, Bird CR, Chapple K, White WL, Little AS (2017) Rater Reliability of the Hardy Classification for Pituitary Adenomas in the Magnetic Resonance Imaging Era. J Neurol Surg B Skull Base. 78(5):413-418.

Hwang J, Seol HJ, Nam DH, Lee JI, Lee MH, Kong DS (2016) Therapeutic Strategy for Cavernous Sinus-Invading Non-Functioning Pituitary Adenomas Based on the Modified Knosp Grading System. Brain Tumor Res Treat. 4(2):63-69.

Bevan JS, Atkin SL, Atkinson AB, Bouloux PM, Hanna F, Harris PE, James RA, McConnell M, Roberts GA, Scanlon MF, Stewart PM, Teasdale E, Turner HE, Wass JA, Wardlaw JM (2002) Primary medical therapy for acromegaly: an open, prospective, multicenter study of the effects of subcutaneous and intramuscular slow-release octreotide on growth hormone, insulin-like growth factor-I, and tumor size. J Clin Endocrinol Metab. 87(10):4554-63.

Colao A, Attanasio R, Pivonello R, Cappabianca P, Cavallo LM, Lasio G, Lodrini A, Lombardi G, Cozzi R (2006) Partial surgical removal of growth hormone-secreting pituitary tumors enhances the response to somatostatin analogs in acromegaly. J Clin Endocrinol Metab. 91(1):85-92.

Figure 1. Volume measurement example




How to Cite

Erkutlu, İbrahim, Demir, A., Üçler, N., Uğur, B. K., Geyik, M., & Nehir, A. (2023). Investigation of the Relationship between Adenoma Volume and Perioperative Hormone Levels in Patients with Acromegaly. European Journal of Therapeutics, 29(4), 759–765.



Original Articles