Diagnosis and Management of pituitary disease with focus on the role of Magnetic Resonance Imaging

Non-coding RNAs and exosomal non-coding RNAs in pituitary adenoma

Pituitary adenoma (PA) is the third most common primary intracranial tumor in terms of overall disease incidence. Although they are benign tumors, they can have a variety of clinical symptoms, but are mostly asymptomatic, which often leads to diagnosis at an advanced stage when surgical intervention is ineffective. Earlier identification of PA could reduce morbidity and allow better clinical management of the affected patients. Non-coding RNAs (ncRNAs) do not generally code for proteins, but can modulate biological processes at the post-transcriptional level through a variety of molecular mechanisms. An increased number of ncRNA expression profiles have been found in PAs. Therefore, understanding the expression patterns of different ncRNAs could be a promising method for developing non-invasive biomarkers. This review summarizes the expression patterns of dysregulated ncRNAs (microRNAs, long non-coding RNAs, and circular RNAs) involved in PA, which could one day serve as innovative biomarkers or therapeutic targets for the treatment of this neoplasia. We also discuss the potential molecular pathways by which the dysregulated ncRNAs could cause PA and affect its progression.

Identification and Verification of SLC27A1, PTBP1 and EIF5A With Significantly Altered Expression in Aggressive Pituitary Adenomas

Background

Aggressive pituitary adenoma encircling the internal carotid artery has a poor clinical prognosis because of a high surgical risk and a high recurrence rate. This seriously affects patients’ quality of life and yet there is no effective medical treatment. The European Diagnostic Guidelines have recommended the use of temozolomide (TMZ) for these aggressive pituitary adenomas, but the treatment remission rate has been less than 50%.

Methods

In this study, transcriptome sequencing of pituitary tumour tissues and TMZ-treated pituitary tumour cell lines were employed to explore the significance gene expressions affecting the efficacy of TMZ treatment for pituitary tumours. To clarify the roles of these gene expressions, six adult patients with pituitary adenomas treated in Tiantan Hospital from 2015 to 2020 and a pituitary adenoma cell line (Att20 sensitive to TMZ treatment) were analyzed by mRNA transcriptome sequencing. The differentially expressed genes were assayed by analyzing the sequencing results, and the expression level of these genes was further verified by immunohistochemistry. In addition, Ki67, VEGF, and p53 of the tumour tissues were also verified by immunohistochemistry.

Results

In tumour tissues, mRNA sequencing showed that PTBP1 and EIF5A were significantly overexpressed in primary pituitary adenomas and SLC27A1 was significantly overexpressed in aggressive pituitary adenomas. Also in the pituitary adenoma cell line (AtT20), SLC27A1 expression levels were suppressed by TMZ treatment. Subsequent immunohistochemistry confirmed the sequencing results.

Conclusion

High expression of SLC27A1 and low expression of EIF5A and PTBP1 may be potential indicators to predict the progression of aggressive pituitary adenomas, and patients with high SLC27A1 subtype may be sensitive to TMZ in clinical treatments.

Radiomic Features on Multiparametric MRI for Preoperative Evaluation of Pituitary Macroadenomas Consistency: Preliminary Findings

BACKGROUND

Preoperative assessment of the consistency of pituitary macroadenomas (PMA) might be needed for surgical planning.

PURPOSE

To investigate the diagnostic performance of radiomics models based on multiparametric magnetic resonance imaging (mpMRI) for preoperatively evaluating the tumor consistency of PMA.

STUDY TYPE

Retrospective.

POPULATION

One hundred and fifty-six PMA patients (soft consistency, N = 104 vs. hard consistency, N = 52), divided into training (N = 108) and test (N = 48) cohorts. The tumor consistency was determined on surgical findings.

FIELD STRENGTH/SEQUENCE

T1-weighted imaging (T1WI), contrast-enhanced T1WI (T1CE), and T2-weighted imaging (T2WI) using spin-echo sequences with a 3.0-T scanner.

ASSESSMENT

An automated three-dimensional (3D) segmentation was performed to generate the volume of interest (VOI) on T2WI, then T1WI/T1CE were coregistered to T2WI. A total of 388 radiomic features were extracted on each VOI of mpMRI. The top-discriminative features were identified using the minimum-redundancy maximum-relevance method and 0.632+ bootstrapping. The radiomics models based on each sequence and their combinations were established via the random forest (RF) and support vector machine (SVM), and independently evaluated for their ability in distinguishing PMA consistency.

STATISTICAL TESTS

Mann-Whitney U-test and Chi-square test were used for comparison analysis. The area under the receiver operating characteristic curve (AUC), accuracy (ACC), sensitivity (SEN), specificity (SPE), and relative standard deviation (RSD) were calculated to evaluate each model's performance. ACC with P-value<0.05 was considered statistically significant.

RESULTS

Eleven mpMRI-based features exhibited statistically significant differences between soft and hard PMA in the training cohort. The radiomics model built on combined T1WI/T1CE/T2WI demonstrated the best performance among all the radiomics models with an AUC of 0.90 (95% confidence interval [CI]: 0.87-0.92), ACC of 0.87 (CI: 0.84-0.89), SEN of 0.83 (CI: 0.81-0.85), and SPE of 0.87 (CI: 0.85-0.99) in the test cohort.

DATA CONCLUSION

Radiomic features based on mpMRI have good performance in the presurgical evaluation of PMA consistency.

LEVEL OF EVIDENCE

3 TECHNICAL EFFICACY: Stage 2.

CircNFIX promotes progression of pituitary adenoma via CCNB1 by sponging miR-34a -5p

Previous studies have shown that CCNB1 affects the invasiveness of pituitary adenomas, and it is of great significance to find the upstream mechanism of regulating CCNB1.In this study, we explored a significantly overexpressed circRNA in invasive pituitary adenomas. Based on bioinformatics analysis and mechanism experiments, we determined that circNFIX (has-circ_0005660) affects cell invasion, migration and proliferation in pituitary adenomas by sponging miR-34a-5p through CCNB1. In pituitary adenoma tissues, the expression of circNFIX and CCNB1 was upregulated, while miR-34a-5p expression was downregulated. The silencing of circNFIX or overexpression of miR-34a-5p inhibited cell invasion, migration and proliferation. Inhibition of miR-34a-5p expression reversed the inhibitory effect of circNFIX silencing on the progression of pituitary adenoma. In conclusion, CircNFIX affects cell invasion, migration, and proliferation in pituitary adenomas by sponging miR-34a-5p through CCNB1. Therefore, circNFIX is expected to serve as a potential target for the treatment of pituitary adenomas.

Suprasellar pituitary adenomas: a 10-year experience in a single tertiary medical center and a literature review

BACKGROUND

Suprasellar pituitary adenomas (SPAs) are a special type of pituitary adenoma. Although dozens of SPA cases have been reported, the exact definition and the characteristics of SPA have not been exhaustively discussed before.

METHODS

In a retrospective electronic medical records review, 13 patients with SPA were identified in our hospital between January 2010 and December 2019. A literature review was performed by searching the online database PubMed, and 39 cases conformed to the criteria based on the previous literature. Data regarding clinical symptoms, imaging manifestations, surgical information and follow-ups were analyzed.

RESULTS

The mean age at diagnosis of 52 patients with SPA was 36.73 years, and most of the patients were female (61.5%). The most common hormone-secreting subtypes of SPA were nonfunctioning (36.5%) and ACTH-secreting (34.6%) SPA. Macroadenomas (68.9%) were more common than microadenomas (31.1%). The origins of the SPAs included the intrasellar pituitary gland (type I), the subdiaphragmatic (type IIa) and supradiaphragmatic (type IIb) part of the pituitary stalk, and the suprasellar peri-infundibular region (type III). The most common anatomic subtype of SPA was type III, and type IIb was also common. The most common presentations of SPA were visual symptoms, especially for type III SPA. In addition, 64.7% and 73.1% of type IIb and III SPAs, respectively, were suspected to be of suprasellar origin based on presurgical imaging examination. Patients with tumors of suspected suprasellar origin were more likely to receive transcranial surgery (TCS) initially than those with tumors of suspected intrasellar origin (70.6% vs. 22.2%, p = 0.0013). The intact rate for the pituitary stalk after surgery for type II SPA was lower than that for type I and III SPA (52.6% vs. 92.6%, p = 0.0036). More patients with type II SPA experienced postoperative central diabetes insipidus (CDI) than those with type I and III SPA (57.9% vs. 11.1%, p = 0.0011). There was no significant difference in the incidence of postoperative CDI between transsphenoidal surgery (TSS) and TCS (p = 0.1304). Nine patients in our hospital received extended endoscopic TSS; only one experienced tumor recurrence, and no severe complications occurred after surgery.

CONCLUSIONS

SPAs could be defined as pituitary adenomas completely or partially located in the suprasellar region. There were both similarities and differences among the different anatomic subtypes of SPA. For patients who were suspected of having SPAs, visual field tests, pituitary hormone evaluation and MRI were necessary. Because imaging examination is not a reliable method, surgery is the only way to confirm the tumor origin. Extended endoscopic TSS might be a safe and efficient approach to remove these tumors, but more studies are needed to verify this conclusion. For type II SPA, the pituitary stalk should be carefully protected during surgery, and postoperative CDI should be monitored.