Investigation of the relationship between perioperative hormon levels and adenom volume in akromegaly patients

OBJECTIVE: Pituitary adenomas show clinical signs by compressing to peripheral neurovascular structures or impairing hormone secretion. Today, surgical approaches provide very successful clinical results in the treatment of pituitary adenomas. However, the classification of pituitary adenomas and the results of surgical treatment are based only on two-dimensional MR image sections and by hormonal measurements. In this study, the relationship between hormone levels and volumetric tumor burden was investigated by measuring tumor volumes before and after surgery in acromegaly patients. MATERIAL and METHODS: In this retrospective clinical study, the clinical, radiological, hormonal, volumetric and surgical outcomes of 52 patients who were diagnosed pituitary adenoma with acromegaly in our clinic between 2010-2016 years were investigated. Before and after surgery, pituitary hormone levels and volumetric data were compared. These measurements were obtained using the 1,47 version of the ImageJ software package and the measure-stack plug-in. In the measurements, thin-section (1 mm) dynamic and static MR images were used. In statistical analyzes, the relationship between tumor volumes and GH, IGF-I levels was investigated before and after surgery. RESULTS: 22 of the 52 cases (%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, and 7 cases (% 13,47) were microadenoma. All of the patients were operated on with 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), volumes(%67) and IGF (%50) levels in the postoperative period(Wilcoxon signed rank test, p <0.05). There was a positive and significant correlation between GH levels and tumor volumes before and after surgery (r: 0,516, r: 0,755, p <0.05). There wasn't correlation between preoperative and postoperative IGF-I levels and tumor volumes (r: :-0,051, p<0.05) (r: :-0,051,p <0.05). There was a positive significant correlation between GH levels and IGF-1 levels in the postoperative period(r: 0,303, p <0.05).No surgical complications were observed in the patients. CONCLUSION: As the tumor volume increases in patients with pituitary adenomas, both GH and IGF-I levels increase significantly. Pre-and post-surgical classification of acromegaly patients may have a significant impact on volumetric measurements when more objective and quantitative detection of tumor residue and recurrence is required.For this reason, we believe that it is more accurate to evaluate the tumor tissues occupying the 3D volume by volumetric measurements. KEY WORDS:Pituitary adenoma, Surgical treatment, Growth hormone, Volum