Cavernous Sinus invasion by Growth-Hormone Secreting Pituitary Adenomas

Introduction: Transsphenoidal resection is the first-line treatment for growth-hormone secreting pituitary adenomas. Somatotropinomas infiltrating the cavernous sinus demonstrate lower remission rates compared with noninfiltrating tumors, likely due to the invasive nature inherent to adenomas involving this site.

Objective: Clinical characteristics differentiating growth-hormone secreting pituitary adenomas with and without cavernous sinus invasion were retrospectively evaluated.

Methods: During the 20-year period between January 2000 and March 2020, 20 patients with growth-hormone secreting pituitary adenomas underwent primary transsphenoidal resection at the University of Oklahoma Health Sciences Center. Preoperative and postoperative data were obtained through review of inpatient and outpatient clinical records.

Results: Mean patient age for the 20 cases of growth-hormone secreting pituitary adenoma was 40.75 years; of them, 13 were female, and 7 were male. Thirteen of 20 adenomas demonstrated invasion of the cavernous sinus. Average length of follow-up was 93.1 weeks. Clinical features of growth-hormone excess (hand/foot enlargement and coarsened facies) were identified at patient presentation for 8 of 13 of patients with cavernous sinus invasion versus two of seven patients without cavernous sinus invasion. Presenting levels of serum IGF-1 and tumor size were significantly higher in subjects with cavernous sinus invasion compared with those without invasion. In addition, the combined finding of persistent postoperative IGF-1 elevation and radiographic evidence of residual tumor was observed in a higher proportion of patients with tumor invading the cavernous sinus (9/13) than in noninvasive cases (1/7). Five of 13 pituitary adenomas with cavernous sinus invasion required retreatment during the study period. None of the noninvasive adenomas required retreatment.

Conclusion: At presentation, growth-hormone secreting adenomas invading the cavernous sinus demonstrated significantly greater tumor size and serum IGF-1 levels than noninvasive adenomas and were more likely to present with clear clinical acromegaly. Postoperatively, the odds of biochemical and radiographic evidence of recurrent disease cooccurring was 13.5% higher for adenomas with cavernous sinus invasion than those without invasion (OR = 13.5 [95% CI: 1.1973–152.2181]).

Cavernous sinus	Preoperative serum IGF-1 (ng/mL), tumor dimension (cm)	Residual tumor and persistently elevated IGF-1(+) [retreatment]
Noninvasive
53, F	977, 1.4
41, M	234, 2.5
45, F	642, 1.4
62, F	216, 1.4
31, M	690, 3.7
38, M	612, 0.5
36, F	709, 0.7
	Mean: 582.9[a], 1.66[b]
Invasive
46, F	604, 1.3	[GKRS]
40, F	665, 2.2	+
18, M	676, 5.9	+
19, M	900, 4.0
18, F	1,269, 2.0	+,[GKRS]
30, F	531, 2.7
53, M	1,467, 2.9	+,[GKRS]
74, F	1,030, 1.2
47, F	541, 4.7	+
50, F	705, 1.7	+
29, F	864, 2.6	+,[TSS]
53, F	473, 2.2	+,[TSS]
32, M	951, 2.8	+
	Mean: 821.2[a], 2.78 [b]

^a p-Value = 0.048.

^b p-Value = 0.038.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021