Avaliação dos aspectos da imagem de ressonância magnética e resultados da hipofisectomia transesfenoidal endoscópica em pacientes acromegálicos

Abstract

Introduction: Acromegaly is a systemic disease that results from excessive production of growth hormone (GH) and insulin-like growth factor 1 (IGF-1). The etiology is most often related to a GH-producing pituitary adenoma. Endonasal endoscopic surgery is currently the treatment of choice. Somatostatin receptor ligands (SRLs) are drugs that can be used as adjuvants in the preoperative and postoperative periods to assist in the treatment of this condition. Some factors have been identified in the literature as predictors of response to SRLs. However, the literature is still incomplete regarding predictors of response to surgical treatment. Objectives: To identify whether GH-producing adenomas that present as hypointense on T2-weighted magnetic resonance imaging behave differently from others, particularly regarding hormonal control rates with surgery when compared to isointense and hyperintense adenomas. Methods: Forty-two medical records of patients who underwent endonasal endoscopic surgery for resection of GH-producing pituitary tumors were retrospectively analyzed. The procedures were performed by the same surgeon from 2005 to 2023 at the Hospital das Clínicas of the Federal University of Minas Gerais. Patients were divided into three groups according to the signal intensity on T2-weighted MRI: hypointense, isointense, and hyperintense. Factors such as age, sex, time from symptom onset to diagnosis, symptomatology, size, sellar/suprasellar extension, degree of cavernous sinus invasion, and pre- and postoperative hormonal control were compared among the three groups. Results: Hypointense tumors were classified as microadenomas (<1 cm in diameter) in 53% of cases, and all were intrasellar. A higher proportion of isointense tumor showed suprasellar extension and those classified as macroadenomas. Among isointense tumors, 23.8% showed cavernous sinus invasion, while no hypo- or hyperintense tumors invaded this structure. In seventy-three percent of hypointense tumors, hormonal control was achieved with surgery alone, while the same results were obtained in only 44% of hyperintense tumors. However, there was no statistically significant difference between the groups. There was also no statistically significant difference considering epidemiological factors such as age, sex, time, and symptom characteristics at diagnosis. Conclusions: Hypointense tumors were all intrasellar and microadenomas. Additionally, there seems to be a greater tendency for hormonal control with surgery alone in these tumors. More robust studies with a larger number of participants are needed to confirm this hypothesis.