Study On Characteristics And Interrelationships Of MRI、 Endocrine Hormone And Pathological Immune Responses Of Acromegalic Pituitary Adenomas

Objective To investigate the characteristics and interrelationships of MRI 、endocrine hormone and pathological immune responses of acromegalic pituitary adenomas, revealed preliminarily the pathological immune mechanism of acromegalic pituitary adenomas.Methods A total of 84 patients with acromegalic pituitary adenoma resected via single-nostril transspheniodal approach form Jan. 2008 to Jun. 2013 were analyzed retrospectively.(1) Tada formula method(xyz/2) was used to calculate the tumor volume(v). preoperative based blood endocrine hormone levels were detected by chemiluminescent immunoassay, the expression of tumor endocrine hormone was detected by immunohistochemistry, research the change law of blood GH level in preoperation and postoperation,and seek for the time windou of tumor cure or remission criterion. the expression of tumor endocrine hormone was detected by immunohistochemistry, analysis the law of tumor endocrine hormone immune response expression and the interrelationships among clinical endocrine hormone levels, tumor biological behavior and tumor size.(2) Related factors of acromegalic pituitary adenoma with secondary diabetic were analyzed by two classification of multi factors Logistic regression through the comparative analysis of their clinical data.Results(1) There wad no significant gender differences in acromegalic pituitary adenoma, male: female = 1:1, the incidence age often concentrated in 41-50 old years,the time from onset to diagnosis focused on 6-10 years. The average optical density of growth hormone(GH)pathological immune response was higher than those of prolactin(PRL), follicle stimulating hormone(FSH), adrenocorticotropin(ACTH), luteinizing hormone(LH)(P=0.047、0.000、0.000、0.000), there were no significant difference(P=0.139) between GH and TSH.The number of tumor positive expression of endocrine immune accounted for GH 62(74%), PRL36(43%), TSH 23(27%); the common type of expression for the GH23(27%), GH+PRL16(19%),PRL+TSH8(10%). Pathological immune positive rate, blood content increasing rate and clinical manifestation positive rates of GH and thyroid stimulation hormone(TSH)were 74%, 99%, 100% and 43%, 15%, 10% respectively, the difference was statistically significant(x2=27.024, P=0.000); Pathological immune positive reaction rate of TSH, ACTH, FSH, LH were 27%, 18%, 10% and 8%, but clinical endocrine hormone determination was in the normal range. there was statistically significant difference among blood GH level of preoperative and postoperative patients at 5 days and 4 weeks(F=19.120, P=19.120). The GH level of 5 days after operation(11.64 +5.83) ng/ml falled more fast than preoperative blood GH(51.14 + 36.01) ng/ml, the difference was statistically significant(P=0.004); the GH level of 4 weeks after operation(5.46 + 4.25) ng/ml still falled slowly, but there was significant difference comparing with the GH level of 5 days after operation(P=0.011).(2) Macroadenomas and giant adenoma accounted for 87%(73/84). MRI showed the tumor which can break the sellar diaphragm to suprasellar and through the saddle floor to the sphenoid sinus. Infrasellar invasion index [(2.35 ± 0.69) cm] was significantly higher than that of suprasellar invasion index [(0.66 ± 0.25) cm], the difference was statistically significant(t=16.128, P=0.000). There was no significant correlation between preoperative basic blood GH level [(35.06 ± 26.68) ng/ml] and tumor size [(7.98 ±5.24) cm3], GH immune response average optical density(AOD) value(0.395 ± 0.383)(r=0.117, P=0.144; r=-0.076, P=0.555; r=-0.066, P =0.609 respectively).(3)Preoperative blood GH level was(42.83 ± 8.70) ng/ml and(38.91 ± 36.46) ng/ml respectively(t=5.253, P=0.031). The percentage of positive thyroid stimulation hormone(TSH) immunoreactivity(70%) was significantly more than that of no secondary diabetes(14%)(P=0.000). Logistic regression results show that Exp(B) and the P values of the time of incidence, the positive rate of serum GH level before operation and TSH immune were 0.212, 1.160, 93.392 and 0.010, 0.004, 0.002, Exp(B) maximum was the positive of TSH immune.Conclusion(1) MRI characteristics of GH-adenomas demonstrated a proclivity for infrasellar extension, it will provide the basis from imaging diagnosis to endocrine function diagnosis.(2) The 28 d postoperative blood GH levels was considered as the standard time window of the judgement for curative effect.(3) Immune expression intensity of GH and TSH were higher than other endocrine hormone, the number of GH, TSH, PRL immune positive were more than the other endocrine hormone, GH and GH+PRL and PRL+TSH were common manifestation type, TSH and PRL of tumor cell secretion may be involved in the pathological and physiological process of acromegalic pituitary adenoma.(4) There was a good consistency between GH pathological immune positive expression and blood endocrine hormone level and clinical biological behavior, but there was no obvious correlation between preoperative basic blood GH level, tumor volume and GH pathological immune response strength, it showed Shows the interconnected and complicated relationships among pathological immune responses, blood endocrine hormone levels and imaging manifestations.(4) Time of incidence, preoperative serum GH and TSH immune positive rate is related factors of acromegalic pituitary adenoma with secondary diabetic, TSH immune positive is the main factor. TSH of tumor cell secretion may be involved in the pathological and physiological process of acromegalic pituitary adenoma with secondary diabetes. For patients of TSH immune positive should not only focus on the development of diabetes, and to strengthen follow-up, but pay more attention on its development for the possibility of malignant tumor, in order to achieve early discovery and treatment of disease.