SFEBES2023 Poster Presentations Neuroendocrinology and Pituitary (74 abstracts)
Development of an optimal imaging pathway for management of somatotroph tumors in acromegaly
Linus Haberbosch 1,2 , James Macfarlane 3 , Olympia Koulouri 3 , Dan Gillett 3 , Joachim Spranger 1 , Knut Mai 1 , Heok Cheow 4 , Jonathan Jones 5 , Christian Strasburger 1 & Mark Gurnell 3
1Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Endocrinology and Metabolism, Berlin, Germany. 2Berlin Institute of Health at Charité – Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Junior Digital Clinician Scientist Program, Berlin, Germany. 3Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome Trust-MRC; Institute of Metabolic Science, University of Cambridge, National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke’s Hospital, Cambridge, United Kingdom. 4Cambridge Endocrine Molecular Imaging Group, Department of Nuclear Medicine, University of Cambridge, National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke’s Hospital, Cambridge, United Kingdom. 5Cambridge Endocrine Molecular Imaging Group, Department of Radiology, University of Cambridge, National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke’s Hospital, Cambridge, United Kingdom
Background: Acromegaly is associated with significant excess morbidity and mortality. Surgery and radiotherapy (including radiosurgery) aim to reduce the burden of growth hormone excess while preserving normal pituitary function, but their effective deployment is dependent on high quality imaging that allows accurate localization of site(s) of active de novo or residual/recurrent disease. Despite the existence of several comprehensive guidelines on the management of acromegaly, there is little consensus regarding imaging, and protocols are heterogeneous. A standardized and optimized imaging pathway could have a positive impact on routine clinical practice and facilitate comparative studies in this rare disorder.
Methods: We summarized existing acromegaly guidelines and performed a systematic review of the literature on cranial imaging for somatotroph adenomas in MEDLINE for studies published between January 1, 1966 and May 1, 2023. Based on the results, we set up a framework and performed a further hybrid search employing Semantic Scholar.
Results: We identified 4 guidelines and 1103 studies, of which 64 were included in our final analysis. The results confirmed a large variability of protocols between studies and centers. Merging the guideline suggestions and results of the systematic review, we have developed a novel hierarchical imaging algorithm for patients with somatotroph tumors, which incorporates advanced anatomical as well as molecular (functional) imaging.
Conclusion: In summary, we propose the use of a common, optimized imaging pathway, incorporating modern modalities and overseen by pituitary tumor centers of excellence (PTCOE). This has the potential to enable more patients with acromegaly to benefit from definitive treatment interventions whilst preserving normal gland function.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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