Growth Hormone-Secreting Pituitary Adenoma: Dura Mater Invasion Is Not a Predictor of Acromegaly Persistence After Trans-Sphenoidal Surgery

Objectives: In pituitary adenomas, examinations of surgical specimens have shown that dural invasion occurs in 42-85% of cases. No studies about dura mater invasion have been conducted specifically in acromegaly patients. The aim of the present study was to evaluate the relationship between histologically dural invasion and the main features of GH-secreting adenomas. Methods: This retrospective study included all consecutive acromegaly patients who underwent neurosurgery at our university hospital between 2017 and 2020. The following data were collected: (1) clinical, biochemical and morphological data at diagnosis, at three months, one year after neurosurgery, and at last follow-up; (2) pathological features (dura mater invasion, immunohistochemical analyses, proliferation index Ki-67, p53, and granulation pattern); and (3) radiological features on magnetic resonance images. Results: Of 35 acromegaly patients, 11 had dural invasion (INV+ 31%) and 24 did not (INV- 69%). GH levels at diagnosis were greater in INV+ patients (p = 0.02), and a GH value > 27 ng/mL was able to distinguish INV+ patients (Sensitivity 80%, Specificity 73%, AUC 0.760, p = 0.006). Indeed, patients with GH > 27 ng/mL at diagnosis had a tenfold greater risk of dura mater invasion (OR 10.7; 95% CI 1.74-65.27, p = 0.005). No differences were found in the other clinical, biochemical, morphological, radiological and pathological features. Regarding remission likelihood, IGF-1 levels at diagnosis were lower in cured patients (p = 0.03). Conclusions: The GH level at diagnosis is the only parameter significantly associated with dura mater invasion. Lower IGF-1 levels at diagnosis are significantly associated with remission one year after surgery.