title: Growth hormone secreting pituitary microadenomas and empty sella - An under-recognized association?
abstract: OBJECTIVE
  To describe an association of growth hormone (GH) secreting pituitary microadenomas and empty sella (ES), which has been described in case reports - the underlying mechanisms are unclear.
  
  
  METHODS
  We retrospectively analyzed patients operated for GH-producing pituitary adenomas between February 2004 and February 2009. Magnetic resonance imaging (MRI), computed tomography (CT) imaging, and pituitary function testing were performed. All cases underwent transsphenoidal surgery (TSS). Mean follow up was 38 months (range 12-80 months).
  
  
  RESULTS
  Out of 152 patients with acromegaly due to GH-producing pituitary adenomas (female:male=73:79; age range 17-63 years), 69 patients had microadenomas (45.4%; 38 females, 31 males). We found 14 cases (14/69, 20.3%), all microadenomas, with presurgical evidence of ES - 10 females (71%) and 4 males (29%) (female:male=2.5:1). When compared with 103 patients with GH-negative microadenomas treated in the same time period (ES in 4 of 103; 3.9%), ES was highly significantly associated with GH production by the microadenoma (p=0.001). In acromegalics with empty sella, no cases of ectopic adenoma were found. Postoperatively, GH and IGF-1 levels fell in all patients, and 7 cases had random GH and IGF-1 levels consistent with cure.
  
  
  CONCLUSIONS
  The combination of GH-producing microadenomas and empty, enlarged sella is not rare. In this setting, preoperative CT scans are very useful and the transsphenoidal approach is efficient and safe. The mechanism underlying the association of GH-producing microadenomas and empty sella remains unclear and requires further studies.
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, 100050 Beijing, China.
authors.forename: Weiming
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, The First People Hospital of Lianyungang, Tongguan Beilu 182, 222002 Lianyungan, Jiangsu, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhou
authors.affiliation: Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091 Zurich, Switzerland.
authors.forename: Marian Christoph
authors.initials: MC
authors.lastname: Neidert
authors.affiliation: Division of Endocrinology and Diabetes, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmid
authors.affiliation: Neurochirurgie Klinik Hirslanden, Witellikerstrasse 40, CH-8032 Zurich, Switzerland.
authors.forename: René-Ludwig
authors.initials: RL
authors.lastname: Bernays
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, 100050 Beijing, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Ni
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, 100050 Beijing, China.
authors.forename: Dabiao
authors.initials: D
authors.lastname: Zhou
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, 100050 Beijing, China.
authors.forename: Wang
authors.initials: W
authors.lastname: Jia
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, 100050 Beijing, China. Electronic address: jiaguijun@cssc.net.cn.
authors.forename: Guijun
authors.initials: G
authors.lastname: Jia
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D004652:Empty Sella Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: Empty sella; Growth hormone (GH); Microadenomas; Neuroimaging; Transsphenoidal approach