Clinical, hormonal and pathomorphological markers of somatotroph pituitary neuroendocrine tumors predicting the treatment outcome in acromegaly

Tomasik, Agnieszka; Stelmachowska-Banaś, Maria; Maksymowicz, Maria; Czajka-Oraniec, Izabella; Raczkiewicz, Dorota; Zieliński, Grzegorz; Kunicki, Jacek; Zgliczyński, Wojciech

doi:10.3389/fendo.2022.957301

Cited by 13 publications

(9 citation statements)

References 67 publications

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“…We found that lower absolute IGF-1 levels at diagnosis were associated with biochemical control after surgery at short-term in corroboration with other studies [ 11 , 30 , 31 ], but not with IGF-1/ULN and not at long-term follow-up. Thus, we do not regard this finding as a helpful predictor of biochemical control.…”

Section: Discussionsupporting

confidence: 92%

“…Moreover, we did not find any variables associated with biochemical control at long-term. Of the few studies reporting long-term follow-up data exceeding three years postoperatively, preoperative GH and IGF-1 levels, tumor size and invasiveness, and age at diagnosis were among factors predicting long-term biochemical control after surgery [ 11 , 17 , 30 , 31 , 33 ]. Presurgical medical treatment may improve control rates [ 15 ], but medical pretreatment as a systematic approach in unselected patients remains controversial [ 8 , 9 , 15 , 22 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…Among earlier series describing surgical outcomes, only a few have long-term follow-up extending to more than three years [ 1 , 7 , 13 , 19 , 24 ]. Lower levels of preoperative GH and IGF-1, smaller and noninvasive tumors, and older age at diagnosis, are among factors that potentially predict surgical outcome and long-term biochemical control [ 11 , 17 , 30 , 31 , 33 ].…”

Section: Introductionmentioning

confidence: 99%

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Long-term control of acromegaly after pituitary surgery in South-Eastern Norway

Falch,

Dupont,

Olarescu

et al. 2023

Acta Neurochir

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Purpose Sustained cure of acromegaly can only be achieved by surgery. Most growth hormone (GH) secreting pituitary adenomas are macroadenomas (≥ 10 mm) at diagnosis, with reported surgical cure rates of approximately 50%. Long-term data on disease control rates after surgery are limited. Our aim was to estimate short- and long-term rates of biochemical control after pituitary surgery in acromegaly and identify predictive factors. Methods Patients operated for GH-secreting pituitary adenomas between 2005–2020 were included from the local pituitary registry (n = 178). Disease activity and treatment data were recorded at one-year (short-term) and five-year (long-term) postoperative follow-up. Biochemical control was defined as insulin-like growth factor 1 (IGF-1) ≤ 1.2 × upper limit of normal value. Multivariate regression models were used to identify factors potentially predicting biochemical control. Results A total of 178 patients with acromegaly (median age at diagnosis 49 (IQR: 38–59) years, 46% women) were operated for a pituitary adenoma. Biochemical control was achieved by surgery in 53% at short-term and 41% at long-term follow-up, without additional treatment for acromegaly. Biochemical control rates by surgery were of same magnitude in paired samples (45% vs. 41%, p = 0.213) for short- and long-term follow-up, respectively. At short-term, 62% of patients with microadenomas and 51% with macroadenomas, achieved biochemical control. At long-term, the biochemical control rate was 58% for microadenomas and 37% for macroadenomas (p = 0.058). With adjunctive treatment, 82% achieved biochemical control at long-term. Baseline IGF-1 levels significantly predicted biochemical control by surgery at short-term (OR: 0.98 (95% CI: 0.96–0.99), p = 0.011), but not at long-term (OR: 0.76 (95% CI: 0.57–1.00), p = 0.053). Conclusion In unselected patients with acromegaly, the long-term biochemical control rate remains modest. Our findings indicate a need to identify patients at an earlier stage and improve therapeutic methods and surgical outcomes.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-term control of acromegaly after pituitary surgery in South-Eastern Norway

Falch,

Dupont,

Olarescu

et al. 2023

Acta Neurochir

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“…[16] Previous study has reported that the lower the GH level of acromegaly patients before treatment, the better the prognosis. [17] But due to the different degree of damage to pituitary function after apoplexy, this pattern was not found in our study.…”

Section: Discussioncontrasting

confidence: 73%

Acromegaly complicated with fulminant pituitary apoplexy: clinical characteristic analysis and review of literature

Zheng

Zhou

Yao

et al. 2023

Preprint

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Purpose To retrospectively summarize the clinical features of acromegaly complicated with fulminant pituitary apoplexy and analyze the prognostic factors to guide early identification and timely treatment of such patients. Methods A retrospective analysis was carried out to summarize the clinical manifestations, hormone changes, imaging, treatment and follow-up of 10 patients with acromegaly complicated with fulminant pituitary apoplexy admitted to our hospital from February 2013 to September 2021. Results The mean age of the 10 patients (5 males and 5 females) at the time of pituitary apoplexy was 37.1 ±13.4 years old. There were 9 cases with sudden severe headache and 5 cases with visual impairment. All patients had pituitary macroadenomas, of which 6 cases with Knosp grade ≥ 3. The level of GH/IGF-1 hormone after pituitary apoplexy was lower compared with pre-apoplexy, and 1 patient reached biochemical remission spontaneously. 7 patients underwent transsphenoidal pituitary surgery after apoplexy and 1 patient was treated with long-acting somatostatin analog. The biochemical remission rate was 37.5% in 8 patients immediately after treatment and 50% at the last follow-up. Patients with Knosp grade ≥ 3 were less likely to achieve biochemical remission than those with Knosp grade < 3 (16.7% vs. 100%, p=0.048), and patients who achieved biochemical remission had a smaller maximum tumor diameter [20.1（20.1,28.0）mm vs. 44.0（44.0,60）mm，p=0.016]. Conclusion Acromegaly complicated with fulminant pituitary apoplexy remains a diagnostic and therapeutic challenge.

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“…Surgical treatment can effectively lead to biochemical control. Furthermore, baseline characteristics that can impact long-term outcomes include age at diagnosis ( 7 ), gender ( 7 ), preoperative serum levels of GH and IGF-1 ( 8 - 13 ), preoperative medication ( 12 ), tumor size ( 8 , 9 , 12 ), invasiveness ( 12 , 14 ), Knosp grading scores ( 8 , 9 , 12 ), and histological pathology [Ki-67, somatostatin receptor subtype 2 expression, arylhydrocarbon receptor inter acting protein (AIP) expression, and granularity] ( 14 ). Therefore, identifying independent factors that predict long-term outcomes, such as biochemical remission or recurrence, may be crucial in facilitating clinical management.…”

Section: Introductionmentioning

confidence: 99%

Using 2-dimensional hand photographs to predict postoperative biochemical remission in acromegaly patients: a transfer learning approach

Wang¹,

Duan²,

Yao³

et al. 2023

Quant Imaging Med Surg

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Background The primary treatment goals in acromegaly patients are complete surgical removal of underlying pituitary tumors and biochemical remission. One of the challenges in developing countries is the difficulty in monitoring postoperative biochemical levels in acromegaly patients, particularly those who live in remote areas or regions with limited medical resources. Methods In an attempt to overcome the abovementioned challenges, we conducted a retrospective study and established a mobile and low-cost method to predict biochemical remission in acromegaly patients after surgery, the efficacy of which was assessed retrospectively using the China Acromegaly Patient Association (CAPA) database. A total of 368 surgical patients from the CAPA database were successfully followed up to obtain their hand photographs. Demographics, baseline clinical characteristics, pituitary tumor features, and treatment details were collated. Postoperative outcome, defined as biochemical remission at the last follow-up timepoint, was assessed. Transfer learning with a new mobile tailored neurocomputing architecture, MobileNetv2, was used to explore the identical features that could be used as predictors of long-term biochemical remission after surgery. Results As expected, the MobileNetv2-based transfer learning algorithm was shown to predict biochemical remission with statistical accuracies of 0.96 and 0.76 in the training cohort (n=803) and validation cohort (n=200), respectively, and the loss function value was 0.82. Conclusions Our findings demonstrate the potential of the MobileNetv2-based transfer learning algorithm in predicting biochemical remission for postoperative patients who are at home or live far away from a pituitary or neuroendocrinological treatment center.

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Clinical, hormonal and pathomorphological markers of somatotroph pituitary neuroendocrine tumors predicting the treatment outcome in acromegaly

Cited by 13 publications

References 67 publications

Long-term control of acromegaly after pituitary surgery in South-Eastern Norway

Long-term control of acromegaly after pituitary surgery in South-Eastern Norway

Acromegaly complicated with fulminant pituitary apoplexy: clinical characteristic analysis and review of literature

Using 2-dimensional hand photographs to predict postoperative biochemical remission in acromegaly patients: a transfer learning approach

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