18F-florodeoksiglukoz pozitron emisyon tomografisinde insidental hipofiz tutulumu: Klinik etkileri ve özellikleri

Year 2025, Volume: 78 Issue: 4, 307 - 312, 31.12.2025

Fatma Nur Korkmaz , Mustafa Sahin , Çiğdem Soydal , Rifat Emral

https://doi.org/10.65092/autfm.1717915

Abstract

Arka plan/amaç: 18F-florodeoksiglukoz (FDG) kullanan pozitron emisyon tomografisi (PET)/BT, malign hastalıklarda evreleme ve/veya lokalizasyon için yaygın olarak kullanılan bir görüntüleme yöntemidir. Çalışmamızın amacı, insidental hipofiz tutulumu olan hastaların klinik laboratuvar ve histopatolojik özelliklerini araştırmaktır.
Materyaller ve yöntemler: Bu retrospektif çalışmada, Mayıs 2012 ile Aralık 2020 arasında çeşitli endikasyonlarla çekilen yaklaşık 60.000 18-FDG PET/BT hipofiz tutulumu olan hastaları belirlemek için incelendi. Bu hastaların klinik ve laboratuvar özellikleri hastane bilgi yönetim sistemi kullanılarak araştırıldı.
Sonuçlar: 18F-FDG PET/BT'de insidental hipofiz tutulumu olan yirmi beş hasta belirlendi. On bir hastada makroadenom vardı. Hipofiz lezyonlarının ve farklı malignitelerin ortalama SUVmax seviyeleri istatistiksel olarak benzerdi (sırasıyla 13,6 (5,40-38,80) ve 11,7 (0,00-116,0). 25 hastanın altısında hormonal değerlendirmeye göre nonfonksiyonel adenom, bir hastada prolaktinoma ve dört hastada hipofiz yetmezliği olduğu saptandı. İki hastada histopatolojik değerlendirmede hipofiz adenomu vardı. Bir hastada radyolojik olarak saptanan akciğer karsinomu metastazı saptandı.
Sonuç: İnsidental hipofiz tutulumu özellikle ileri metastatik hastalığı olan hastalarda göz ardı edilmektedir. Kemoterapi, cerrahi ve diğer müdahaleler nedenilye ciddi fizyolojik strese maruz kalan malignitesi olan bireylerde, hipofiz yetmezliğinin zamanında teşhis edilmesi ve yönetimi, morbidite ve mortaliteyi önemli ölçüde etkileyebileceğinden çok önemlidir. Tanısal algoritmalar, öngörücü modeller ve sistematik takip stratejileri geliştirmek için hem primer malignite hem de hipofiz metastazları hakkında kapsamlı hormonal, radyolojik ve histopatolojik verilerin kullanıldığı prospektif çalışmalara ihtiyaç vardır.

Keywords

hipofiz tutulumu , malignite , 18F-florodeoksi glukoz pozitron emisyon tomografisi

Incidental Pituitary Uptake on 18F-fluorodeoxyglucose positron emission tomography: Clinical Implications and characteristics

Abstract

Background/aim: Positron emission tomography (PET)/CT using 18F-fluorodeoxyglucose (FDG) is a commonly used technique for staging and/or localization in various malignant diseases. Our study aimed to investigate the clinical laboratory and histopathological features of patients with incidental pituitary involvement.
Materials and methods: In this retrospective study, approximately 60,000 18-FDG PET/CT scans performed for various indications between May 2012 and December 2020 were reviewed to identify patients with pituitary involvement. The clinical and laboratory characteristics of these patients were investigated using the Hospital Information Management System.
Results: Twenty-five patients with incidental pituitary uptake were identified on 18F-FDG PET/CT scans. Eleven patients had macroadenomas. The mean SUVmax levels of the pituitary lesions and different malignancies were statistically similar (13.6 (5.40–38.80) and 11.7 (0.00–116.0), respectively. Six of the 25 patients had nonfunctional adenomas, one patient had a prolactinoma, and four patients had pituitary insufficiency based on hormonal evaluation. Two patients were found to have a pituitary adenoma on histopathological evaluation. One patient had a metastasis from lung carcinoma, as detected radiologically.
Conclusion: Incidental pituitary uptake is often overlooked, particularly in the patients with advanced metastatic disease. In individuals with a primary malignancy who are subjected to significant physiological stress from chemotherapy, surgery, and other interventions, timely diagnosing and management of pituitary insufficiency is crucial, as it can significantly impact morbidity and mortality. To develop diagnostic algorithms, predictive models, or systematic follow-up strategies, prospective studies are needed that include hormonal, radiological, and histopathological follow-up data on both the primary malignancy and pituitary metastases.

Keywords

18F-fluorodeoxyglucose positron emission tomography , pituitary uptake , malignancy

Supporting Institution

none

References

• Chapman PR, Singhal A, Gaddamanugu S, et al: Neuroimaging of the Pituitary Gland: Practical Anatomy and Pathology. Radiol Clin North Am 2020; 58:1115-1133.
• Expert Panel on Neurologic I, Burns J, Policeni B, et al: ACR Appropriateness Criteria((R)) Neuroendocrine Imaging. J Am Coll Radiol 2019; 16:S161-S173.
• Rennert J, Doerfler A: Imaging of sellar and parasellar lesions. Clin Neurol Neurosurg 2007; 109:111-24.
• Cardona-Rovira MG, Casan-Fernandez R, Sanz-Gallur J, et al: Pituitary metastasis of solid tumors: 2 cases of different presentation. Endocrinol Diabetes Nutr (Engl Ed) 2019; 66:202-203:
• Iglesias P, Cardona J, Diez JJ: The pituitary in nuclear medicine imaging. Eur J Intern Med 2019; 68:6-12. Jeong SY, Lee SW, Lee HJ, et al: Incidental pituitary uptake on whole-body 18F-FDG PET/CT: a multicentre study. Eur J Nucl Med Mol Imaging 2010; 37:2334-43.
• Hyun SH, Choi JY, Lee KH, et al: Incidental focal 18F-FDG uptake in the pituitary gland: clinical significance and differential diagnostic criteria. J Nucl Med 2011; 52:547-50.
• Ju H, Zhou J, Pan Y, et al: Evaluation of pituitary uptake incidentally identified on (18)F-FDG PET/CT scan. Oncotarget 2017; 8:55544-55549.
• Seok H, Lee EY, Choe EY, et al: Analysis of 18F-fluorodeoxyglucose positron emission tomography findings in patients with pituitary lesions. Korean J Intern Med 2013; 28:81-8.
• Stanly A, Sunny SS, Benjamin J, et al: Utility of F18-FDG PET/CT in the Evaluation of Pituitary Uptake. World J Nucl Med 2024; 23:234-241.
• MacFarlane J, Bashari WA, Senanayake R, et al: Advances in the Imaging of Pituitary Tumors. Endocrinol Metab Clin North Am 2020; 49:357-373.
• Campeau RJ, David O, Dowling AM: Pituitary adenoma detected on FDG positron emission tomography in a patient with mucosa-associated lymphoid tissue lymphoma. Clin Nucl Med 2003; 28:296-8.
• Ryu SI, Tafti BA, Skirboll SL: Pituitary adenomas can appear as hypermetabolic lesions in (18) F-FDG PET imaging. J Neuroimaging 2010; 20:393-6.
• Soussan M, Wartski M, Ezra J, et al: Non-Hodgkin lymphoma localization in the pituitary gland: diagnosis by FDG-PET/CT. Clin Nucl Med 2008; 33:111-2.
• Alzahrani AS, Farhat R, Al-Arifi A, et al: The diagnostic value of fused positron emission tomography/computed tomography in the localization of adrenocorticotropin-secreting pituitary adenoma in Cushing's disease. Pituitary 2009; 12:309-14.