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

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 pitui...

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Detalles Bibliográficos
Autores: Araujo-Castro, M, Biagetti, B, Torre, EM, Novoa-Testa, I, Cordido, F, Corrales, EP, Berrocal, VR, Guerrero-Pérez, F, Vicente, A, Percovich, JC, Centeno, RG, González, L, García, MDO, Echarri, AI, Rodríguez, MDM, Novo-Rodríguez, C, Calatayud, M, Villar, R, Bernabéu, I, Alvarez-Escola, C, Valderrama, PB, Tenorio-Jimenéz, C, Galiana, PA, Moreno, EV, Molero, IG, Iglesias, P, Blanco, C, De Lara, FVO, de Miguel, P, Mezquita, EL, Hanzu, F, Aldecoa, I, Lamas, C, Aznar, S, Aulinas, A, Calabrese, A, Gracia, P, Recio-Córdova, JM, Aviles, M, Asensio-Wandosel, D, Sampedro, M, Ruz-Caracuel, I, Camara, R, Paja, M, Fajardo-Montañana, C, Marazuela, M, Puig-Domingo, M
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2024
País:España
Institución:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
Repositorio:r-FISABIO. Repositorio Institucional de Producción Científica
OAI Identifier:oai:fisabio.fundanetsuite.com:p18025
Acceso en línea:https://fisabio.portalinvestigacion.com/publicaciones/18025
Access Level:acceso abierto
Palabra clave:acromegaly
pituitary adenoma
prolactin
surgical remission
mixed tumors
Descripción
Sumario: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.

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