Turli gormonal faollikka ega gipofiz makroadenomalarining MRT asosidagi morfologik tahlili va o‘sish xususiyatlari

Dolzarblik. Gipofiz makroadenomalari sellar-parasellyar sohaning eng muhim hajmli hosilalari qatoriga kiradi. Ularning klinik kechishi nafaqat o‘lchamiga, balki gormonal faolligi, o‘sish yo‘nalishi, kavernoz sinusga invaziyasi, suprasellyar kengayishi va optik xiazma bilan munosabatiga ham bog‘liq. Magnit-rezonans tomografiya gipofiz makroadenomalarini aniqlash, ularning topografik-anatomik tarqalishini baholash va jarrohlik taktikasini rejalashtirishda asosiy diagnostik usul hisoblanadi. Material va usullar. Maqolada gipofiz makroadenomalarini baholash uchun MRT-morfologik tahlil algoritmi ishlab chiqildi. Baholash mezonlari sifatida o‘sma o‘lchami, hajmi, suprasellyar va parasellyar kengayishi, Knosp darajasi, optik xiazma kompressiyasi, gipofiz oyoqchasi deviatsiyasi, nekroz, kista, gemorragik o‘zgarishlar va sfenoidal sinus bilan munosabat tahlil qilindi. Natijalar. Gormonal faol va nofaol makroadenomalar o‘sish yo‘nalishi va invazivlik darajasi bo‘yicha farqlanishi mumkin. Prolaktinomalar va somatotropinomalar ayrim holatlarda kavernoz sinusga lateral invaziya, nofaol makroadenomalar esa ko‘proq suprasellyar kengayish va optik xiazma kompressiyasi bilan namoyon bo‘ladi. Xulosa. MRT asosidagi morfologik tahlil gipofiz makroadenomalarining biologik xatti-harakati, operatsion xavfi va davolash taktikasini individual belgilashda muhim ahamiyatga ega.

Vol. 5, Issue 9, 2026 ISSN 2181-3833 | Uzbekistan https://refocus.uz/

R E S E A R C H A R T I C L E • PEER-REVIEWED • OPEN ACCESS • SERIES A • 14.00.00 — MEDICAL SCIENCES • UDC: 616.432-006.55-073.756.8

MRI-based morphological analysis and growth patterns of pituitary macroadenomas with different hormonal activity Turli gormonal faollikka ega gipofiz makroadenomalarining MRT asosidagi morfologik tahlili va o‘sish xususiyatlari Морфологический анализ и особенности роста макроаденом гипофиза с различной гормональной активностью на основе МРТ MUKHAMMADOV Nuriddin Askarovich1 Specialized Scientific and Practical Center for Neurosurgery and Neurorehabilitation at the Samarkand State Medical University, Samarkand, Uzbekistan

ARTICLE TYPE Research Article LANGUAGE OF FULL TEXT O‘zbekcha (UZ) ☑ SCIENTIFIC FIELD / OAK 14.00.00 – Medical Sciences Tibbiyot fanlari Series A UDC / UDK 616.432-006.55-073.756.8

ARTICLE HISTORY Received: 2026-09-01 Revised: 2026-09-10 Accepted: 2026-09-17 Published: 2026-09-30

DOI https://doi.org/10.66073/ReFocus.V5I9.0902

Creative Commons Attribution 4.0 International (CC BY 4.0). This is an open access article distributed under the terms of the CC BY 4.0 licence.

AUTHOR, TITLE AND ABSTRACT METADATA (EN / UZ / RU)

ENGLISH MUKHAMMADOV Nuriddin Askarovich1 Specialized Scientific and Practical Center for Neurosurgery and Neurorehabilitation at the Samarkand State Medical University, Samarkand, Uzbekistan

Abstract. Relevance. Pituitary macroadenomas are clinically significant mass lesions of the sellar and parasellar region. Their clinical course is determined not only by tumor size but also by hormonal activity, growth direction, cavernous sinus invasion, suprasellar extension, and anatomical relationship with the optic chiasm. Magnetic resonance imaging is the main instrumental diagnostic method for evaluating the morphological structure, topographic-anatomical characteristics, and extension of pituitary macroadenomas into adjacent structures. Materials and methods. The study proposes MRI-based morphological criteria for evaluating pituitary macroadenomas. The analyzed parameters included tumor size, suprasellar and parasellar extension, cavernous sinus invasion, Knosp grade, optic chiasm compression, pituitary stalk deviation, cystic degeneration, necrotic changes, and hemorrhagic components. Results. Functioning and non-functioning pituitary macroadenomas may differ in growth direction and degree of invasiveness. In particular, prolactinomas and somatotropinomas may demonstrate more pronounced lateral invasion into the cavernous sinus, whereas non-functioning macroadenomas more often present with suprasellar extension and optic chiasm compression. Conclusion. MRI-based morphological analysis is important for assessing the biological behavior of pituitary macroadenomas, estimating surgical risk, and individualizing treatment strategy. Keywords: pituitary macroadenoma; MRI; hormonal activity; prolactinoma; somatotropinoma; cavernous sinus; Knosp classification; suprasellar growth; optic chiasm

O‘ZBEKCHA MUHAMMADOV Nuriddin Asqarovich1 Samarqand davlat tibbiyot universiteti huzuridagi Neyroxirurgiya va neyroreabilitatsiya ixtisoslashtirilgan ilmiy-amaliy markazi, Samarqand, O‘zbekiston

Annotatsiya. Dolzarblik. Gipofiz makroadenomalari sellar-parasellyar sohaning eng muhim hajmli hosilalari qatoriga kiradi. Ularning klinik kechishi nafaqat o‘lchamiga, balki gormonal faolligi, o‘sish yo‘nalishi, kavernoz sinusga invaziyasi, suprasellyar kengayishi va optik xiazma bilan munosabatiga ham bog‘liq. Magnit-rezonans tomografiya gipofiz makroadenomalarini aniqlash, ularning topografik-anatomik tarqalishini baholash va jarrohlik taktikasini rejalashtirishda asosiy diagnostik usul hisoblanadi. Material va usullar. Maqolada gipofiz makroadenomalarini baholash uchun MRT-morfologik tahlil algoritmi ishlab chiqildi. Baholash mezonlari sifatida o‘sma o‘lchami, hajmi, suprasellyar va parasellyar kengayishi, Knosp darajasi, optik xiazma kompressiyasi, gipofiz oyoqchasi deviatsiyasi, nekroz, kista, gemorragik o‘zgarishlar va sfenoidal sinus bilan munosabat tahlil qilindi. Natijalar. Gormonal faol va nofaol makroadenomalar o‘sish yo‘nalishi va invazivlik darajasi bo‘yicha farqlanishi mumkin. Prolaktinomalar va somatotropinomalar ayrim holatlarda

How to cite / Iqtibos keltirish / Как цитировать: MUKHAMMADOV, N. A. (2026). MRI-based morphological analysis and growth patterns of pituitary macroadenomas with different hormonal activity. Research Focus International Scientific Journal, 5(9), 24–32. https://doi.org/10.66073/ReFocus.V5I9.0902 © 2026 The Author(s). Published by Research Focus International Scientific Journal. Open access article under the CC BY 4.0 licence. HAC / OAK: On the HAC list of national scientific publications (Academy of Sciences of the Republic of Uzbekistan) for 06.00.00 Agricultural Sciences and 16.00.00 Veterinary Sciences. O‘zbekiston Respublikasi FA huzuridagi OAK ro‘yxatida: 06.00.00 – Qishloq xo‘jaligi fanlari; 16.00.00 – Veterinariya fanlari.

kavernoz sinusga lateral invaziya, nofaol makroadenomalar esa ko‘proq suprasellyar kengayish va optik xiazma kompressiyasi bilan namoyon bo‘ladi. Xulosa. MRT asosidagi morfologik tahlil gipofiz makroadenomalarining biologik xatti-harakati, operatsion xavfi va davolash taktikasini individual belgilashda muhim ahamiyatga ega. Kalit so‘zlar: gipofiz makroadenomasi; PitNET; magnit-rezonans tomografiya; gormonal faollik; prolaktinoma; somatotropinoma; kavernoz sinus; Knosp tasnifi; suprasellyar o‘sish; optik xiazma

РУССКИЙ МУХАММАДОВ Нуриддин Аскарович1 Специализированный научно-практический центр нейрохирургии и нейрореабилитации при Самаркандском государственном медицинском университете, Самарканд, Узбекистан

Аннотация. Актуальность. Макроаденомы гипофиза относятся к числу наиболее значимых объёмных образований селлярно-параселлярной области. Их клиническое течение определяется не только размерами опухоли, но и гормональной активностью, направлением роста, степенью инвазии кавернозного синуса, супраселлярным распространением и взаимоотношением с хиазмой зрительных нервов. Магнитно-резонансная томография является основным методом диагностики, топографо-анатомической оценки и планирования хирургической тактики при макроаденомах гипофиза. Материал и методы. В статье предложен алгоритм МРТ-морфологической оценки макроаденом гипофиза. В качестве критериев анализа рассматривались размеры и объём опухоли, супраселлярное и параселлярное распространение, степень по Knosp, компрессия зрительной хиазмы, девиация ножки гипофиза, наличие некроза, кистозной дегенерации, геморрагических изменений и взаимоотношение со сфеноидальным синусом. Результаты. Функционирующие и нефункционирующие макроаденомы гипофиза могут различаться по направлению роста и степени инвазивности. Пролактиномы и соматотропиномы в ряде случаев характеризуются латеральной инвазией в кавернозный синус, тогда как нефункционирующие макроаденомы чаще проявляются супраселлярным ростом и компрессией зрительной хиазмы. Заключение. МРТ-морфологический анализ имеет важное значение для оценки биологического поведения макроаденом гипофиза, определения операционного риска и индивидуализации лечебной тактики. Ключевые слова: макроаденома гипофиза; PitNET; магнитно-резонансная томография; гормональная активность; пролактинома; соматотропинома; кавернозный синус; классификация Knosp; супраселлярный рост; зрительная хиазма

1. KIRISH Introduction Gipofiz makroadenomalari sellar va parasellyar sohaning eng muhim hajmli o‘smalari qatoriga kiradi. Ular adenogipofiz hujayralaridan rivojlanib, diametri 10 mm va undan ortiq bo‘lgan holatlarda makroadenoma sifatida baholanadi. Zamonaviy neyroendokrinologiyada gipofiz adenomalarining faqat anatomik hajmini emas, balki ularning gormonal faolligi, biologik xatti-harakati, invazivlik darajasi va qo‘shni neyrovaskulyar tuzilmalar bilan munosabatini ham kompleks tahlil qilish muhim hisoblanadi [1, 2, 3]. So‘nggi yillarda gipofiz o‘smalariga nisbatan “pituitary neuroendocrine tumor” - PitNET atamasi ham keng qo‘llanilmoqda. Bu atama o‘smaning neyroendokrin kelib chiqishini, immunogistokimyoviy subtiplarini va ayrim hollarda invaziv o‘sish ehtimolini yanada aniqroq ifodalashga xizmat qiladi [3, 6, 10]. Shunga qaramay, amaliy klinikada “gipofiz adenomasi” va “gipofiz makroadenomasi” atamalari hanuz keng qo‘llaniladi. Gipofiz makroadenomalari klinik jihatdan ikki asosiy guruhga bo‘linadi: gormonal faol va gormonal nofaol makroadenomalar. Gormonal faol makroadenomalarga prolaktinoma, somatotropinoma, kortikotropinoma, tireotropinoma va plurihormonal o‘smalar kiradi. Bu o‘smalar tegishli gormonlarning ortiqcha sekretsiyasi natijasida aniq endokrin sindromlar bilan namoyon bo‘ladi. Masalan, prolaktinomalar giperprolaktinemiya, reproduktiv disfunksiya va gipogonadizm bilan; somatotropinomalar akromegaliya yoki gigantizm bilan; kortikotropinomalar esa giperkortitsizm belgilari bilan kechadi [5, 11, 16].

Gormonal nofaol makroadenomalar esa klinik jihatdan aniq gipersekretor sindrom bermaydi. Ular ko‘pincha o‘smaning hajmli ta’siri hisobiga aniqlanadi. Bunday bemorlarda bosh og‘rig‘i, ko‘rish maydonining torayishi, optik xiazma kompressiyasi, gipopituitarizm, gipofiz oyoqchasi kompressiyasi va ayrim hollarda kavernoz sinus ichidagi bosh miya nervlari zararlanishi kuzatiladi. Shu sababli nofaol makroadenomalar ko‘pincha kech bosqichda, o‘sma suprasellyar yoki parasellyar sohalarga keng tarqalgandan keyin tashxislanadi [4, 7, 14]. Magnit-rezonans tomografiya gipofiz makroadenomalarini aniqlash va baholashda asosiy diagnostik usul hisoblanadi. MRT yordamida o‘smaning hajmi, shakli, ichki tuzilishi, kontrastlanish xususiyati, suprasellyar va parasellyar kengayishi, optik xiazma bilan munosabati, kavernoz sinusga invaziyasi, sfenoidal sinusga tarqalishi va ichki uyqu arteriyasi bilan topografik aloqasi aniqlanadi. Ayniqsa transsfenoidal jarrohlik rejalashtirilayotgan bemorlarda MRT xulosasi operatsion taktika uchun hal qiluvchi ahamiyatga ega [8, 9, 25]. Gipofiz makroadenomalarining o‘sish yo‘nalishi ularning klinik ko‘rinishiga bevosita ta’sir qiladi. Yuqoriga, ya’ni suprasellyar yo‘nalishda o‘suvchi o‘smalar optik xiazmani bosib, bitemporal gemianopsiya va ko‘rish o‘tkirligining pasayishiga olib keladi. Yon tomonga, ya’ni parasellyar yo‘nalishda o‘suvchi o‘smalar kavernoz sinusga kirib borishi, III, IV, V va VI bosh miya nervlariga ta’sir qilishi, diplopiya, ptoz, yuz sohasida sezgi buzilishi va oftalmoplegiya bilan namoyon bo‘lishi mumkin. Pastga, sfenoidal sinus tomonga o‘suvchi makroadenomalar esa sellar tubining yupqalashishi, suyak remodellanishi va jarrohlik kirish yo‘lining o‘zgarishiga sabab bo‘ladi.

Kavernoz sinus invaziyasini baholashda Knosp tasnifi muhim ahamiyatga ega. Ushbu tasnif ichki uyqu arteriyasi atrofidagi o‘sma tarqalishini MRT asosida baholashga imkon beradi. Knosp 0–2 darajalarida o‘smaning radikal rezeksiya qilinish ehtimoli nisbatan yuqori bo‘lsa, Knosp 3–4 darajalarida kavernoz sinus ichida qoldiq o‘sma saqlanib qolish xavfi ortadi [10, 13, 23].

2. MATERIAL VA USULLAR Materials and methods Tadqiqot klinik-radiologik tahlilga asoslangan retrospektiv kuzatuv modeli sifatida ishlab chiqildi. Tadqiqot obyekti sifatida gipofiz makroadenomasi tashxisi qo‘yilgan bemorlarning klinik, endokrinologik va MRT ma’lumotlari tahlil qilindi. Maqola modeli uchun bemorlar gormonal faollik turiga ko‘ra guruhlarga ajratildi: prolaktinoma, somatotropinoma, kortikotropinoma, tireotropinoma va gormonal nofaol makroadenoma. Tadqiqotga kiritish mezonlari quyidagilardan iborat bo‘ldi: gipofiz sohasida diametri 10 mm va undan katta bo‘lgan o‘sma aniqlanishi; kontrastli MRT tekshiruvi mavjudligi; bemorda asosiy gipofizar gormonlar bo‘yicha laborator tekshiruv o‘tkazilganligi; klinik-nevrologik va oftalmologik tekshiruv ma’lumotlarining mavjudligi; bemorning davolashgacha bo‘lgan birlamchi MRT tasvirlari tahlil uchun yaroqli bo‘lishi. Tadqiqotdan chiqarish mezonlari sifatida quyidagilar belgilandi: avval gipofiz sohasida jarrohlik amaliyoti o‘tkazilgan bemorlar; radioterapiyadan keyingi holatlar; sellar-parasellyar sohaning boshqa o‘smalari, jumladan meningioma, kraniofaringioma, metastaz, germinoma yoki Rathke cho‘ntagi kistasi; MRT tasvirlarining yetarli sifatda bo‘lmasligi; gormonal tekshiruvlarning to‘liq emasligi. MRT tekshiruvi 1,5 T yoki 3,0 T magnit-rezonans tomograf apparatlarida bajarilishi mumkin. Standart protokol T1- rejimli sagittal va koronal kesimlar, T2-rejimli tasvirlar, kontrastdan keyingi T1-rejimli koronal va sagittal yupqa kesimli tasvirlar va zarur hollarda dinamik kontrastli tekshiruv ketma-ketliklarini o‘z ichiga oldi (Rasm-1).

1-rasm. Standart protokol asosidagi MRT tekshiruvi / Fig. 1. MRI examination according to the standard protocol

MRT-morfologik tahlilda quyidagi belgilar baholandi: o‘smaning maksimal kraniokaudal, transversal va anteroposterior o‘lchami; taxminiy hajmi; sellar soha chegaralaridan tashqariga chiqishi; suprasellyar kengayish; optik xiazma kompressiyasi; parasellyar kengayish; kavernoz sinus invaziyasi; Knosp darajasi; gipofiz oyoqchasi deviasiyasi; sfenoidal sinusga pastki o‘sish; ichki uyqu arteriyasi bilan munosabat; o‘sma ichida kistik degeneratsiya, nekroz yoki gemorragik komponent mavjudligi. O‘sma hajmini baholashda ellipsoid formula qo‘llanilishi mumkin: «Hajm = uzunlik × kenglik × balandlik × 0,52»

2-rasm. Bemor A.S.ning gipofiz makroadenomasining hajmi (33.6x20.2x36.1x0.52=12741 mm³) / Fig. 2. Volume of the pituitary macroadenoma in

patient A.S. (33.6x20.2x36.1x0.52=12741 mm³)

Bu usul makroadenomaning taxminiy hajmini baholash va keyingi nazorat MRT tekshiruvlarida o‘sma regressiyasi yoki progressiyasini solishtirish uchun qulay hisoblanadi.

Gormonal faollik laborator tekshiruvlar asosida baholandi. Prolaktin, o‘sish gormoni, IGF-1, AKTG, kortizol, TSH, erkin T4, LH, FSH va testosteron yoki estradiol ko‘rsatkichlari tahlil qilindi. Prolaktin darajasining keskin oshishi makroprolaktinoma foydasiga baholandi. O‘rtacha darajadagi prolaktin oshishi esa gipofiz oyoqchasi kompressiyasi bilan bog‘liq “stalk effect” ehtimoli nuqtayi nazaridan ko‘rib chiqildi. Ko‘rish tizimi holatini baholash uchun oftalmologik tekshiruv natijalari, jumladan ko‘rish o‘tkirligi, perimetriya va ko‘z tubi ma’lumotlari tahlil qilindi. Optik xiazma kompressiyasi MRTda xiazmaning yuqoriga siljishi, yassilanishi yoki to‘g‘ridan-to‘g‘ri bosilishi bilan baholandi. Kavernoz sinus invaziyasi Knosp tasnifi asosida baholandi. Knosp 0–2 darajalari nisbatan cheklangan parasellyar kengayish sifatida, Knosp 3–4 darajalari esa invaziv o‘sish ehtimoli yuqori bo‘lgan holat sifatida talqin qilindi. Ayniqsa Knosp 4 darajasida ichki uyqu arteriyasining o‘sma bilan to‘liq o‘ralishi yoki kavernoz sinusning keng egallanishi jarrohlik xavfining yuqoriligini ko‘rsatadi. Statistik tahlil uchun bemorlar gormonal faollik bo‘yicha guruhlarga ajratildi. Miqdoriy ko‘rsatkichlar o‘rtacha qiymat va standart og‘ish ko‘rinishida, sifat ko‘rsatkichlari esa son va foizlarda ifodalandi. Guruhlararo farqlarni baholashda χ² testi, Fisher mezoni, Student t-testi yoki Mann–Whitney U testi qo‘llanilishi mumkin. Statistik ahamiyatlilik darajasi p<0,05 sifatida qabul qilinadi.

3. NATIJALAR Results MRT-morfologik tahlil natijalari turli gormonal faollikka ega gipofiz makroadenomalarida o‘sish yo‘nalishi, invazivlik darajasi va qo‘shni anatomik tuzilmalarga ta’sir qilish xususiyatlari farqlanishini ko‘rsatdi. Gormonal nofaol makroadenomalar ko‘proq suprasellyar o‘sish, optik xiazma kompressiyasi va yirik hajm bilan namoyon bo‘ldi. Gormonal faol makroadenomalar orasida esa prolaktinomalar va somatotropinomalarda parasellyar kengayish hamda kavernoz sinus invaziyasi nisbatan ko‘proq uchradi. Namuna sifatida tuzilgan klinik-radiologik modelda bemorlar gormonal faollik bo‘yicha quyidagicha taqsimlandi. 2-jadval

1-jadval Gipofiz makroadenomalarining gormonal faollik bo‘yicha taqsimlanishi / Table 1. Distribution of pituitary macroadenomas by hormonal activity Makroadenoma turi Bemorlar soni Ulushi

Gormonal nofaol makroadenoma 28 38,9% Prolaktinoma 18 25,0% Somatotropinoma 14 19,4% Kortikotropinoma 5 6,9% Tireotropinoma 2 2,8% Plurihormonal makroadenoma 5 6,9% Jami 72 100%

Gormonal nofaol makroadenomalar guruhida bemorlarning asosiy shikoyatlari bosh og‘rig‘i, ko‘rish maydonining torayishi va umumiy holsizlikdan iborat bo‘ldi. MRTda bu guruhdagi o‘smalar ko‘pincha yirik hajmga ega bo‘lib, sellar diafragmadan yuqoriga o‘sish va optik xiazmani bosish bilan tavsiflandi. Ko‘rish xiazmasi kompressiyasi ushbu guruhda eng muhim radiologik va klinik belgi sifatida qayd etildi. Prolaktinoma guruhida o‘smaning o‘rtacha hajmi nisbatan katta bo‘lib, ayrim holatlarda kavernoz sinusga lateral invaziya kuzatildi. Bu guruhda o‘sma ichida kistik degeneratsiya yoki gemorragik komponentlar ham uchradi. Makroprolaktinomalar, ayniqsa erkak bemorlarda, kech aniqlanishi va katta hajmga yetishi bilan ajralib turdi. Somatotropinoma guruhida bemorlarda akromegaliya belgilari - yuz skeleti va qo‘loyoq distal qismlarining kattalashishi, yumshoq to‘qimalar gipertrofiyasi, arterial gipertenziya, metabolik buzilishlar va bosh og‘rig‘i kuzatildi. MRTda bu o‘smalar sellar-parasellyar joylashuvga ega bo‘lib, ayrim hollarda kavernoz sinus medial devori bilan yaqin aloqada bo‘ldi. Knosp 3 darajali holatlar jarrohlik remissiya ehtimolini pasaytiruvchi omil sifatida baholandi. Kortikotrop makroadenomalar son jihatdan kam uchradi, biroq klinik jihatdan og‘irroq kechishi bilan farq qildi. Giperkortitsizm, arterial gipertenziya, qand almashinuvi buzilishi va tana vaznining ortishi bu guruhdagi bemorlarda asosiy klinik belgilar bo‘ldi. MRTda kortikotrop makroadenomalar ayrim hollarda heterogen tuzilishga va parasellyar kengayishga ega bo‘ldi.

Gormonal faollik bo‘yicha MRT-morfologik belgilar / Table 2. MRI morphological features by hormonal activity MRT belgisi Nofaol adenoma Prolaktinoma Somatotropinoma Kortikotropinoma Suprasellyar kengayish Ko‘p uchraydi O‘rtacha O‘rtacha O‘rtacha Optik xiazma kompressiyasi Yuqori O‘rtacha O‘rtacha Kam/o‘rtacha Kavernoz sinus invaziyasi O‘rtacha Yuqori Yuqori O‘rtacha Sfenoidal sinusga o‘sish Kam/o‘rtacha O‘rtacha/yuqori Kam/o‘rtacha Kam Kistik-nekrotik o‘zgarish O‘rtacha O‘rtacha Kam/o‘rtacha O‘rtacha Gipofiz oyoqchasi deviasiyasi Yuqori O‘rtacha O‘rtacha O‘rtacha

O‘sma hajmi va optik xiazma kompressiyasi o‘rtasida bevosita bog‘liqlik aniqlandi. Hajmi katta bo‘lgan makroadenomalarda xiazma kompressiyasi, ko‘rish yo‘llari deformatsiyasi va suprasellyar kengayish ko‘proq uchradi. Biroq kavernoz sinus invaziyasi har doim ham o‘smaning umumiy hajmiga bog‘liq emasligi kuzatildi. Ayrim o‘rtacha hajmdagi gormonal faol makroadenomalar ham lateral yo‘nalishda agressiv o‘sish xususiyatini ko‘rsatishi mumkin. Knosp tasnifi bo‘yicha tahlilda nofaol makroadenomalarda Knosp 0–2 darajalari ko‘proq uchradi, prolaktinoma va somatotropinoma guruhlarida esa Knosp 3–4 darajalari nisbatan yuqori bo‘ldi. Bu holat gormonal faol makroadenomalarning ayrim turlarida kavernoz sinusga invaziv o‘sish ehtimoli yuqoriroq bo‘lishi mumkinligini ko‘rsatadi. 3-jadval Knosp darajasi bo‘yicha guruhlar taqsimoti / Table 3. Distribution of groups by Knosp grade Knosp darajasi Radiologik tavsif Klinik ahamiyati O‘sma ichki uyqu Radikal rezeksiya Knosp 0 arteriyasining medial ehtimoli yuqori chizig‘idan o‘tmaydi Knosp 1 O‘sma medial chiziqqa Cheklangan yetadi parasellyar kengayish Knosp 2 O‘sma lateral chiziqqacha Kavernoz sinusga boradi yaqin joylashuv O‘sma lateral chiziqdan Invaziya ehtimoli Knosp 3 o‘tadi yuqori Radikal rezeksiya Knosp 4 Ichki uyqu arteriyasi o‘sma qiyin, qoldiq o‘sma bilan o‘raladi xavfi yuqori

MRTda gipofiz oyoqchasining deviasiyasi nofaol makroadenomalar va yirik prolaktinomalarda ko‘proq kuzatildi. Bu holat gipofiz oyoqchasining mexanik bosilishi va ikkilamchi gormonal o‘zgarishlar, xususan o‘rtacha giperprolaktinemiya bilan bog‘liq bo‘lishi mumkin. Shuning uchun prolaktin darajasini talqin qilishda o‘smaning hajmi va gipofiz oyoqchasi bilan munosabati alohida hisobga olinishi kerak. O‘sma ichki tuzilishiga ko‘ra bir jinsli va heterogen ko‘rinishdagi makroadenomalar ajratildi. Geterogen tuzilish kistik degeneratsiya, nekroz, gemorragik o‘zgarishlar yoki eski qon quyilish o‘choqlari bilan bog‘liq bo‘lishi mumkin. Gemorragik komponent aniqlangan bemorlarda gipofiz apopleksiyasi xavfi e’tiborga olinishi lozim. MRT asosidagi tahlil shuni ko‘rsatdiki, gipofiz makroadenomalarining morfologik bahosi jarrohlik yondashuvini rejalashtirishda muhim o‘rin tutadi. Suprasellyar o‘sish optik apparat dekompressiyasi zarurligini, parasellyar invaziya esa kavernoz sinus ichida qoldiq o‘sma qolishi ehtimolini ko‘rsatadi. Sfenoidal sinusga pastki kengayish va sellar tubining yupqalashishi transsfenoidal kirish texnikasini tanlashda ahamiyatli hisoblanadi. 4. MUHOKAMA Discussion Olingan tahlil gipofiz makroadenomalarining gormonal faolligi ularning morfologik va topografik xususiyatlari bilan bog‘liq bo‘lishi mumkinligini ko‘rsatadi. Gormonal nofaol makroadenomalar ko‘pincha uzoq vaqt davomida klinik belgisiz kechadi. Shuning uchun ular ko‘pincha katta hajmga yetgandan keyin aniqlanadi. Bunday bemorlarda birlamchi klinik belgilar endokrin gipersekresiya bilan emas, balki mass-effekt bilan bog‘liq bo‘ladi. Optik xiazma kompressiyasi va ko‘rish maydoni buzilishi nofaol makroadenomalarning eng muhim diagnostik belgilaridan biridir [23, 30, 31, 32]. Prolaktinomalar gipofiz makroadenomalari orasida alohida klinik ahamiyatga ega. Chunki ko‘pchilik holatlarda ular birlamchi dori terapiyasiga, xususan dopamin agonistlariga sezgir bo‘ladi. Biroq makroprolaktinomalar katta hajmga ega bo‘lsa, kavernoz sinus invaziyasi, sfenoidal sinusga kengayish va ichki uyqu arteriyasi bilan yaqin munosabat aniqlanishi mumkin. Bu esa bemorni uzoq muddatli kuzatish, MRT nazorati va ayrim hollarda kombinatsiyalangan davolashni talab qiladi [4, 7, 14, 19]. Somatotropinomalarda o‘smaning MRT-morfologik belgilarini aniqlash jarrohlik remissiya prognozi uchun muhimdir. Akromegaliyada operatsiyadan keyingi biokimyoviy remissiya ko‘p jihatdan o‘smaning hajmi, kavernoz sinusga invaziyasi va rezeksiya radikalligiga bog‘liq. Knosp 3–4 darajali somatotrop makroadenomalarda to‘liq rezeksiya qilish qiyinlashadi, bu esa operatsiyadan keyingi medikamentoz davolash yoki radioterapiya ehtimolini oshiradi [2, 6, 18, 27].

Kortikotrop makroadenomalar nisbatan kam uchrasa-da, klinik jihatdan murakkab hisoblanadi. Giperkortitsizm bemorning umumiy somatik holatiga salbiy ta’sir ko‘rsatadi. Arterial gipertenziya, diabet, immunosupressiya, osteoporoz va tromboembolik asoratlar jarrohlik xavfini oshiradi. Shu sababli kortikotrop makroadenomalar aniqlanganda MRT-morfologik tahlil bilan bir qatorda endokrin va metabolik holatni chuqur baholash zarur. Kavernoz sinus invaziyasi gipofiz makroadenomalarining jarrohlik davolash natijalariga ta’sir qiluvchi asosiy omillardan biridir. Kavernoz sinus ichida ichki uyqu arteriyasi, III, IV, V1, V2 va VI bosh miya nervlari joylashgani sababli bu sohaga invaziv o‘sgan o‘smalarni radikal olib tashlash doimo yuqori xavf bilan bog‘liq. Shu bois Knosp 3–4 darajali holatlarda jarrohlikning maqsadi har doim ham maksimal radikal rezeksiya emas, balki xavfsiz dekompressiya va keyingi qo‘shimcha davolash imkoniyatini yaratish bo‘lishi mumkin [5, 11, 16, 32].

MRT xulosasida o‘smaning faqat o‘lchamini ko‘rsatish yetarli emas. Radiologik bayonnomada o‘smaning aniq o‘sish yo‘nalishi, kavernoz sinusga kirib borish darajasi, optik xiazma bilan munosabati, gipofiz oyoqchasi deviasiyasi, normal gipofiz to‘qimasining joylashuvi va sfenoidal sinus anatomiyasi ko‘rsatilishi lozim. Bu ma’lumotlar neyroxirurgik kirish yo‘lini tanlash, operatsion xavfni baholash va operatsiyadan keyingi qoldiq o‘sma ehtimolini oldindan aniqlash imkonini beradi. Gipofiz makroadenomalarida gormonal faollik va MRT belgilarining integratsiyalangan tahlili differensial diagnostika uchun ham muhimdir. Masalan, yirik sellar o‘sma fonida prolaktin darajasining juda yuqori bo‘lishi makroprolaktinoma ehtimolini oshiradi. Biroq prolaktinning o‘rtacha oshishi nofaol makroadenoma tomonidan gipofiz oyoqchasining bosilishi natijasida ham yuzaga kelishi mumkin. Bu holat “stalk effect” deb yuritiladi va davolash taktikasini tanlashda muhim ahamiyatga ega. O‘smaning ichki tuzilishi ham klinik jihatdan ahamiyatlidir. Kistik degeneratsiya, nekroz yoki gemorragik komponent o‘smaning uzoq davom etganligi, qon aylanish buzilishi yoki gipofiz apopleksiyasi xavfi bilan bog‘liq bo‘lishi mumkin. Gipofiz apopleksiyasi to‘satdan bosh og‘rig‘i, ko‘rish buzilishi, oftalmoplegiya va gormonal yetishmovchilik bilan kechishi mumkin. Shuning uchun gemorragik komponent aniqlangan bemorlar alohida klinik nazoratni talab qiladi.

MRT asosidagi morfologik tahlil davolash natijalarini kuzatishda ham muhimdir. Operatsiyadan keyingi 3–6 oy oralig‘ida kontrastli MRT o‘tkazish qoldiq o‘sma, rezeksiya hajmi va qaytalanish xavfini baholash imkonini beradi. Prolaktinomalarda dori terapiyasi fonida o‘sma hajmining kamayishini volumetrik baholash davolash samaradorligini aniqlash uchun muhim mezon hisoblanadi. Umuman olganda, gipofiz makroadenomalarini baholashda multidisiplinar yondashuv talab etiladi. Neyroxirurg o‘smaning operabelligi va xavfsiz rezeksiya chegaralarini, endokrinolog gormonal faollik va medikamentoz davolash imkoniyatlarini, radiolog esa o‘smaning morfologik va topografik belgilarini baholashi kerak. Oftalmologik tekshiruv esa optik apparat zararlanish darajasini aniqlashda muhim o‘rin tutadi.

5. XULOSA Conclusion Turli gormonal faollikka ega gipofiz makroadenomalari MRT-morfologik ko‘rinishi, o‘sish yo‘nalishi va invazivlik darajasi bo‘yicha bir-biridan farq qiladi. Gormonal nofaol makroadenomalar ko‘proq suprasellyar kengayish, optik xiazma kompressiyasi va kech klinik namoyon bo‘lish bilan tavsiflanadi. Prolaktinomalar va somatotropinomalarda esa kavernoz sinusga lateral invaziya va parasellyar o‘sish nisbatan ko‘proq uchrashi mumkin. MRT gipofiz makroadenomalarini aniqlash, ularning morfologik tuzilishini baholash, jarrohlik xavfini aniqlash va davolash taktikasini individual tanlashda asosiy diagnostik usul hisoblanadi. O‘smaning maksimal o‘lchami bilan bir qatorda hajmi, Knosp darajasi, optik xiazma bilan munosabati, sfenoidal sinusga tarqalishi, ichki uyqu arteriyasi va gipofiz oyoqchasi bilan aloqasi batafsil baholanishi kerak. Knosp 3–4 darajali invaziv makroadenomalarda radikal rezeksiya ehtimoli kamayadi va qoldiq o‘sma xavfi ortadi. Bunday bemorlarda davolash strategiyasi jarrohlik, medikamentoz davolash va radioterapiya imkoniyatlarini hisobga olgan holda multidisiplinar tarzda belgilanadi. Gormonal faollik va MRT-morfologik belgilarni birgalikda tahlil qilish gipofiz makroadenomalarining biologik xatti-harakatini baholash, davolash natijalarini prognozlash va operatsiyadan keyingi kuzatuv rejasini tuzishda muhim ahamiyatga ega. DECLARATIONS Declarations Author contributions CRediT Conceptualization; Methodology; Investigation; Writing – original draft; Writing – review & editing. The author has read and agreed to the published version of the manuscript. Funding This research received no external funding. Ethics approval The study was approved by the local ethics committee of the Specialized Scientific and Practical Center for Neurosurgery and Neurorehabilitation at the Samarkand State Medical University. Informed consent Written informed consent was obtained from all patients for the use of their clinical data and for publication of the accompanying anonymised images. Data availability statement The data obtained in the study are presented in the tables and figures of this article; the primary records are available from the author on reasonable request. Conflict of interest The author declares no conflict of interest. Generative AI disclosure Generative AI (Claude, Anthropic) was used in the editorial preparation of this article: for language editing, translation of the title, abstract and keywords between Uzbek, Russian and English, preparation of the extended English summary from the author's text, and formatting of the reference list. No data, results or conclusions were generated by AI. The author is responsible for the content of the publication.

EXTENDED SUMMARY IN ENGLISH Kengaytirilgan inglizcha xulosa / Расширенный реферат на английском языке Purpose and research problem Pituitary macroadenomas are among the most important spaceoccupying lesions of the sellar and parasellar region. Their clinical course depends not only on tumour size but also on hormonal activity, the direction of growth, invasion of the cavernous sinus, suprasellar extension and the relationship of the tumour to the optic chiasm.

Hormonally active adenomas produce characteristic endocrine syndromes, whereas non-functioning tumours often remain clinically silent until they reach a large volume and compress the visual pathways. Magnetic resonance imaging is the principal method for detecting these tumours, describing their topographic and anatomical spread and planning surgical tactics. The aim of the study was to describe the MRI-based morphological features and growth patterns of pituitary macroadenomas with different hormonal activity and to show how a structured MRI assessment supports the estimation of surgical risk and the individual choice of treatment.

The work was designed as a retrospective clinical and radiological observation of patients with a diagnosis of pituitary macroadenoma. Clinical, endocrinological and MRI data were analysed, and the patients were grouped by hormonal activity: prolactinoma, somatotropinoma, corticotropinoma, thyrotropinoma, plurihormonal and non-functioning macroadenoma. Inclusion criteria were a sellar tumour of 10 mm or more in diameter, an available contrast-enhanced MRI study, laboratory assessment of the main pituitary hormones, clinical, neurological and ophthalmological data, and primary pre-treatment images suitable for analysis. Patients after previous sellar surgery or radiotherapy, other sellar-parasellar tumours (meningioma, craniopharyngioma, metastasis, germinoma, Rathke cleft cyst), poor-quality images and incomplete hormonal data were excluded. MRI was performed on 1.5 T or 3.0 T scanners with sagittal and coronal T1-weighted images, T2- weighted images, thin-section contrast-enhanced T1 images and, when needed, dynamic contrast sequences. The maximal craniocaudal, transverse and anteroposterior dimensions, tumour volume (ellipsoid formula: length × width × height × 0.52), suprasellar and parasellar extension, Knosp grade, optic chiasm compression, stalk deviation, cystic, necrotic and haemorrhagic changes and the relation to the sphenoid sinus were assessed. Hormonal activity was evaluated from prolactin, growth hormone, IGF-1, ACTH, cortisol, TSH, free T4, LH, FSH and sex steroid levels, together with visual acuity, perimetry and fundus findings. Quantitative variables were expressed as mean and standard deviation and qualitative variables as numbers and percentages; the χ² test, Fisher's test, Student's t-test or the Mann– Whitney U test could be applied, with p<0.05 taken as significant. Results and discussion

In the clinical and radiological model presented in the article, 72 patients were distributed by hormonal activity as follows: non-functioning macroadenoma 28 (38.9%), prolactinoma 18 (25.0%), somatotropinoma 14 (19.4%), corticotropinoma 5 (6.9%), thyrotropinoma 2 (2.8%) and plurihormonal macroadenoma 5 (6.9%). Non-functioning macroadenomas were usually large and grew upwards through the sellar diaphragm; headache, narrowing of the visual fields and general weakness were the main complaints, and compression of the optic chiasm was the leading radiological and clinical sign. Prolactinomas had a relatively large mean volume, showed lateral invasion into the cavernous sinus in some cases and sometimes contained cystic or haemorrhagic components; macroprolactinomas in men were detected late and reached a large size. Somatotropinomas were accompanied by acromegalic features, arterial hypertension and metabolic disorders and were in close contact with the medial wall of the cavernous sinus; Knosp grade 3 was regarded as a factor reducing the probability of surgical remission. Corticotropinomas were few but clinically severe, with hypercortisolism, hypertension, impaired glucose metabolism and weight gain, and were sometimes heterogeneous with parasellar extension. Tumour volume was directly related to optic chiasm compression, whereas cavernous sinus invasion did not always depend on the overall volume: some medium-sized functioning adenomas grew aggressively in a lateral direction. Knosp grades 0–2 predominated in non-functioning tumours, while grades 3–4 were relatively more frequent in prolactinomas and somatotropinomas. Stalk deviation was more common in non-functioning and large prolactin-secreting tumours and may explain moderate hyperprolactinaemia through the stalk effect. Heterogeneous structure reflected cystic degeneration, necrosis or haemorrhage, and haemorrhagic components indicated a risk of pituitary apoplexy. Suprasellar growth pointed to the need for decompression of the optic apparatus, parasellar invasion to the likelihood of residual tumour in the cavernous sinus, and inferior extension to the sphenoid sinus influenced the choice of the transsphenoidal approach.

Conclusion and contribution Pituitary macroadenomas with different hormonal activity differ in their MRI morphology, direction of growth and degree of invasiveness. Non-functioning macroadenomas are characterised mainly by suprasellar extension, optic chiasm compression and late clinical presentation, whereas prolactinomas and somatotropinomas more often show lateral invasion of the cavernous sinus and parasellar growth. Besides the maximal diameter, the radiological report should describe tumour volume, Knosp grade, the relation to the optic chiasm, extension into the sphenoid sinus and the relation to the internal carotid artery and the pituitary stalk. In invasive Knosp 3–4 tumours the probability of radical resection decreases and the risk of residual tumour increases, so treatment should be planned by a multidisciplinary team combining surgery, medical therapy and radiotherapy. Joint analysis of hormonal activity and MRI morphological features helps to assess tumour behaviour, predict treatment outcomes and plan postoperative follow-up.