Differences Between GH- and PRL-Cosecreting and GH-Secreting Pituitary Adenomas: a Series of 604 Cases

被引:8
作者
Araujo-Castro, Marta [1 ]
Betina Biagetti [2 ]
Torre, Edelmiro Menendez [3 ]
Novoa-Testa, Iria [4 ]
Cordido, Fernando [4 ]
Pascual Corrales, Eider [1 ]
Rodriguez Berrocal, Victor [5 ]
Guerrero-Perez, Fernando [6 ]
Vicente, Almudena [7 ]
Carlos Percovich, Juan [8 ]
Garcia Centeno, Rogelio [8 ]
Gonzalez, Laura [8 ]
Ollero Garcia, Maria Dolores [9 ]
Irigaray Echarri, Ana [9 ]
Moure Rodriguez, Maria Dolores [10 ]
Novo-Rodriguez, Cristina [11 ]
Calatayud, Maria [12 ]
Villar, Rocio [13 ]
Bernabeu, Ignacio [13 ]
Alvarez-Escola, Cristina [14 ]
Benitez Valderrama, Pamela [14 ]
Tenorio-Jimenez, Carmen [11 ]
Abellan Galiana, Pablo [15 ]
Venegas Moreno, Eva [16 ]
Gonzalez Molero, Inmaculada [17 ]
Iglesias, Pedro [18 ]
Blanco, Concepcion [19 ]
Vidal-Ostos De Lara, Fernando [19 ]
de Miguel, Paz [20 ]
Lopez Mezquita, Elena [21 ]
Hanzu, Felicia [22 ]
Aldecoa, Iban [23 ,24 ]
Lamas, Cristina [25 ]
Aznar, Silvia [25 ]
Aulinas, Anna [26 ]
Calabrese, Anna [27 ,28 ]
Gracia, Paola [29 ]
Maria Recio-Cordova, Jose [30 ]
Aviles, Mariola [21 ]
Asensio-Wandosel, Diego [31 ]
Sampedro, Miguel [32 ]
Ruz-Caracuel, Ignacio [33 ]
Camara, Rosa [34 ]
Paja, Miguel [35 ]
Fajardo-Montanana, Carmen [36 ]
Marazuela, Monica [32 ]
Puig-Domingo, Manel [31 ]
机构
[1] Hosp Univ Ramon y Cajal, Endocrinol & Nutr Dept, Colmenar Viejo St Km 9, Madrid 28034, Spain
[2] Hosp Univ Vall Hebron, Endocrinol & Nutr Dept, Pg Vall dHebron 119, Barcelona 08035, Spain
[3] Hosp Univ Cent Asturias, Endocrinol & Nutr Dept, Asturias 33011, Spain
[4] Hosp Univ Coruna, Endocrinol & Nutr Dept, Coruna 15006, Spain
[5] Hosp Univ Ramon y Cajal, Neurosurg Dept, Madrid 28034, Spain
[6] Hosp Univ Bellvitge, Endocrinol & Nutr Dept, Cataluna Lhospitalet Llo 08907, Spain
[7] Hosp Univ Toledo, Endocrinol & Nutr Dept, Toledo 45007, Spain
[8] Hosp Univ Gregorio Maranon, Endocrinol & Nutr Dept, Madrid 28007, Spain
[9] Hosp Univ Navarra, Endocrinol & Nutr Dept, Pamplona 31008, Spain
[10] Hosp Univ Cruces, Endocrinol & Nutr Dept, Bilbao 48903, Spain
[11] Hosp Univ Virgen de las Nieves, Endocrinol & Nutr Dept, Granada 18014, Spain
[12] Hosp Univ Doce Octubre, Endocrinol & Nutr Dept, Madrid 28041, Spain
[13] Hosp Univ Santiago de Compostela, Endocrinol & Nutr Dept, Galicia 15706, Spain
[14] Hosp Univ La Paz, Endocrinol & Nutr Dept, Madrid 28046, Spain
[15] Hosp Univ Castellon, Endocrinol & Nutr Dept, Valencia 12004, Spain
[16] Hosp Univ Virgen del Rocio, Endocrinol & Nutr Dept, Seville 41013, Spain
[17] Hosp Reg Univ Malaga, Endocrinol & Nutr Dept, Malaga 29010, Spain
[18] Hosp Univ Puerta de Hierro, Endocrinol & Nutr Dept, Madrid 28222, Spain
[19] Hosp Univ Principe Asturias, Endocrinol & Nutr Dept, Madrid 28805, Spain
[20] Hosp Clin San Carlos, Endocrinol & Nutr Dept, Madrid 28040, Spain
[21] Hosp Univ Clin San Cecilio, Endocrinol & Nutr Dept, Granada 18016, Spain
[22] Hosp Clin Barcelona, Endocrinol & Nutr Dept, Barcelona 08036, Spain
[23] Univ Barcelona, Biomed Diagnost Ctr, Pathol Dept, Hosp Clin, Barcelona 08036, Spain
[24] Hosp Clin Barcelona, Neurol Tissue Bank Biobank, FCRB IDIBAPS, Barcelona 08036, Spain
[25] Hosp Univ Albacete, Endocrinol & Nutr Dept, Albacete 02008, Spain
[26] Hosp Santa Creu & Sant Pau, Endocrinol & Nutr Dept, CIBERER U747 ISCIII, IR St PAU, Barcelona 08025, Spain
[27] Internal Med Dept, I-10043 Turin, Italy
[28] Hosp San Luigi Gonzaga, IR SANTPAU, I-10043 Turin, Italy
[29] Hosp Royo Villanova, Endocrinol & Nutr Dept, Zaragoza 50015, Spain
[30] Hosp Univ Salamanca, Endocrinol & Nutr Dept, Salamanca 37007, Spain
[31] Hosp Badalona Germans Trias & Pujol, Endocrinol & Nutr Dept, Barcelona 08916, Spain
[32] Hosp Univ La Princesa, Endocrinol & Nutr Dept, Madrid 28006, Spain
[33] Hosp Univ Ramon y Cajal, Anatomopathol Dept, Madrid 28034, Spain
[34] Hosp La Fe, Endocrinol & Nutr Dept, Valencia 46026, Spain
[35] Univ Basque Country UPV EHU, Hosp Univ Basurto, Endocrinol & Nutr Dept, OSI Bilbao Basurto, Bilbao 48013, Spain
[36] Hosp Univ La Ribera, Endocrinol & Nutr Dept, Valencia 46600, Spain
关键词
acromegaly; pituitary adenoma; prolactin; surgical remission; mixed tumors; SOMATOSTATIN ANALOGS; HYPERPROLACTINEMIA; CONSENSUS; CRITERIA; CURE;
D O I
10.1210/clinem/dgae126
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context: Few data exist about the clinical course of acromegaly, surgical and medical outcomes in patients with GH- and prolactin cosecreting pituitary adenomas (GH&PRL-PAs). Nevertheless, some series described a more aggressive clinic-radiological behavior than in growth hormone-secreting pituitary adenomas (GH-PAs). Objective: This work aims to evaluate differences in clinical presentation and in surgical outcomes between GH-PAs and GH&PRL-PAs. Methods: A multicenter retrospective study was conducted of 604 patients with acromegaly who underwent pituitary surgery. Patients were classified into 2 groups according to serum PRL levels at diagnosis and immunohistochemistry (IHC) for PRL: a) GH&PRL-PAs when PRL levels were above the upper limit of normal (ULN) and IHC for GH and PRL was positive or PRL levels were greater than 100ng/dL and PRL IHC was not available (n = 130) and b) GH-PA patients who did not meet the previously mentioned criteria (n = 474). Results: GH&PRL-PAs represented 21.5% (n = 130) of patients with acromegaly. The mean age at diagnosis was lower in GH&PRL-PAs than in GH-PAs (P < .001). GH&PRL-PAs were more frequently macroadenomas (90.6% vs 77.4%; P = .001) and tended to be more invasive (33.6% vs 24.7%; P = .057) than GH-PAs. Furthermore, they had presurgical hypopituitarism more frequently (odds ratio 2.8; 95% CI, 1.83-4.38). Insulin-like growth factor ULN levels at diagnosis were lower in patients with GH&PRL-PAs (median 2.4 [interquartile range (IQR) 1.73-3.29] vs 2.7 [IQR 1.91-3.67]; P = .023). There were no differences in the immediate (41.1% vs 43.3%; P = .659) or long-term postsurgical acromegaly biochemical cure rate (53.5% vs 53.1%; P = .936) between groups. However, there was a higher incidence of permanent arginine-vasopressin deficiency (AVP-D) (7.3% vs 2.4%; P = .011) in GH&PRL-PA patients. Conclusion: GH&PRL-PAs are responsible for 20% of acromegaly cases. These tumors are more invasive, larger, and cause hypopituitarism more frequently than GH-PAs and are diagnosed at an earlier age. The biochemical cure rate is similar between both groups, but patients with GH&PRL-PAs tend to develop permanent postsurgical AVP-D more frequently.
引用
收藏
页码:E2178 / E2187
页数:10
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