Differences between GH and PRL co-secreting and GH-secreting pituitary adenomas. A series of 604 cases.

Autor: Araujo-Castro M; Endocrinology & Nutrition Department. Hospital Universitario Ramón y Cajal. Madrid, Spain & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS)., Biagetti B; Endocrinology & Nutrition Department. Hospital Universitario Vall de Hebrón. Barcelona, Spain., Menéndez Torre E; Endocrinology & Nutrition Department. Hospital Universitario Central de Asturias. Asturias, Spain & Instituto de Investigación Sanitaria del Principado de Asturias (ISPA)., Novoa-Testa I; Endocrinology & Nutrition Department. Hospital Universitario de Coruña. Coruña, Spain., Cordido F; Endocrinology & Nutrition Department. Hospital Universitario de Coruña. Coruña, Spain., Pascual Corrales E; Endocrinology & Nutrition Department. Hospital Universitario Ramón y Cajal. Madrid, Spain & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS)., Rodríguez Berrocal V; Neurosurgery Department. Hospital Universitario Ramón y Cajal.  Madrid, Spain., Guerrero-Pérez F; Endocrinology & Nutrition Department. Hospital Universitario de Bellvitge. Cataluña L'Hospitalet de Llobregat, Spain., Vicente A; Endocrinology & Nutrition Department. Hospital Universitario de Toledo.  Toledo, Spain., Percovich JC; Endocrinology & Nutrition Department. Hospital Universitario Gregorio Marañón. Madrid. Spain., García Centeno R; Endocrinology & Nutrition Department. Hospital Universitario Gregorio Marañón. Madrid. Spain., González L; Endocrinology & Nutrition Department. Hospital Universitario Gregorio Marañón. Madrid. Spain., Ollero García MD; Endocrinology & Nutrition Department. Hospital Universitario Navarra.  Pamplona, Spain., Irigaray Echarri A; Endocrinology & Nutrition Department. Hospital Universitario Navarra.  Pamplona, Spain., Moure Rodríguez MD; Endocrinology & Nutrition Department. Hospital Universitario de Cruces.  Bilbao, Spain., Novo-Rodríguez C; Endocrinology & Nutrition Department. Hospital Universitario Virgen de las Nieves.  Granada, Spain., Calatayud M; Endocrinology & Nutrition Department. Hospital Universitario Doce de Octubre.  Madrid, Spain., Villar R; Endocrinology & Nutrition Department. Hospital Universitario de Santiago de Compostela.  Madrid, Spain., Bernabéu I; Endocrinology & Nutrition Department. Hospital Universitario de Santiago de Compostela.  Madrid, Spain., Alvarez-Escola C; Endocrinology & Nutrition Department. Hospital Universitario La Paz.  Madrid, Spain., Benítez Valderrama P; Endocrinology & Nutrition Department. Hospital Universitario La Paz.  Madrid, Spain., Tenorio-Jimenéz C; Endocrinology & Nutrition Department. Hospital Universitario Virgen de las Nieves.  Granada, Spain., Abellán Galiana P; Endocrinology & Nutrition Department. Hospital Universitario de Castellón.  Valencia, Spain., Venegas Moreno E; Endocrinology & Nutrition Department. Hospital Universitario Virgen del Rocío.  Sevilla, Spain., González Molero I; Endocrinology & Nutrition Department. Hospital Regional Universitario de Málaga.  Málaga, Spain., Iglesias P; Endocrinology & Nutrition Department. Hospital Universitario Puerta de Hierro.  Madrid, Spain., Blanco C; Endocrinology & Nutrition Department. Hospital Universitario Príncipe de Asturias.  Madrid, Spain., Vidal-Ostos De Lara F; Endocrinology & Nutrition Department. Hospital Universitario Príncipe de Asturias.  Madrid, Spain., de Miguel P; Endocrinology & Nutrition Department. Hospital Clínico San Carlos.  Madrid, Spain., López Mezquita E; Endocrinology & Nutrition Department. Hospital Universitario Clínico San Cecilio. Granada, Spain., Hanzu F; Endocrinology & Nutrition Department. Hospital Clinic de Barcelona.  Barcelona, Spain., Aldecoa I; Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Barcelona. Neurological Tissue Bank of the Biobank, FCRB-IDIBAPS-Hospital Clinic Barcelona, Barcelona., Lamas C; Endocrinology & Nutrition Department. Hospital Universitario De Albacete, Albacete, Spain., Aznar S; Endocrinology & Nutrition Department. Hospital Universitario De Albacete, Albacete, Spain., Aulinas A; Endocrinology & Nutrition Department. Hospital de la Santa Creu i Sant Pau, IR-SANT PAU, CIBERER U747 (ISCIII), Barcelona, Spain., Calabrese A; Internal Medicine Department. Hospital San Luigi Gonzaga, Turín, Italia and IR-SANTPAU, Barcelona, Spain., Gracia P; Endocrinology & Nutrition Department. Hospital Royo Villanova. Zaragoza. Spain., Recio-Córdova JM; Endocrinology & Nutrition Department. Hospital Universitario de Salamanca. Salamanca, Spain., Aviles M; Endocrinology & Nutrition Department. Hospital Universitario Clínico San Cecilio. Granada, Spain., Asensio-Wandosel D; Endocrinology & Nutrition Department. Hospital Universitario Germans Trias i Pujol.  Cataluña, Spain., Sampedro M; Endocrinology & Nutrition Department. Hospital Universitario La Princesa  Madrid, Spain., Ruz-Caracuel I; Anatomopathological Department. Hospital Universitario Ramón y Cajal. Madrid, Spain & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS)., Camara R; Endocrinology & Nutrition Department. Hospital La Fe.  Valencia, Spain., Paja M; Endocrinology & Nutrition Department. OSI Bilbao-Basurto. Hospital Universitario de Basurto. Bilbao, Spain & University of the Basque Country UPV/EHU., Fajardo-Montañana C; Endocrinology & Nutrition Department. Hospital Universitario La Ribera.  Valencia, Spain., Marazuela M; Endocrinology & Nutrition Department. Hospital Universitario La Princesa  Madrid, Spain., Puig-Domingo M; Endocrinology & Nutrition Department. Hospital Universitario Germans Trias i Pujol.  Cataluña, Spain.
Jazyk: angličtina
Zdroj: The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2024 Mar 04. Date of Electronic Publication: 2024 Mar 04.
DOI: 10.1210/clinem/dgae126
Abstrakt: Purpose: To evaluate differences in clinical presentation and in surgical outcomes between growth hormone-secreting pituitary adenomas (GH-PAs) and GH and prolactin co-secreting pituitary adenomas (GH&PRL-PAs).
Methods: Multicenter retrospective study of 604 patients with acromegaly submitted to pituitary surgery. Patients were classified into two 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 and IHC for GH and PRL was positive or PRL levels were >100ng/and PRL IHC was not available (n=130) and b) GH-PAs 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<0.001). GH&PRL-PAs were more frequently macroadenomas (90.6% vs. 77.4%, P=0.001) and tended to be more invasive (33.6% vs. 24.7%, P=0.057) than GH-PAs. Furthermore, they had presurgical hypopituitarism more frequently (OR 2.8, 95% CI 1.83-4.38). IGF-1 upper limit of normality (ULN) levels at diagnosis were lower in patients with GH&PRL-PAs (median 2.4 [IQR 1.73-3.29] vs. 2.7 [IQR 1.91-3.67], P=0.023). There were no differences in the immediate (41.1% vs 43.3%, P=0.659) or long-term post-surgical acromegaly biochemical cure rate (53.5% vs. 53.1%, P=0.936) between groups. However, there was a higher incidence of permanent arginine-vasopressin deficiency (AVP-D) (7.3% vs. 2.4%, P=0.011) in GH&PRL-PAs patients.
Conclusions: 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.
(© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze: MEDLINE
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