Predictors of therapeutic failure in GH and prolactin co-secreting pituitary adenomas

Aim: To evaluate which factors are associated with a higher probability of failure to surgical and first-generation somatostatin receptor ligands (fgSRLs) treatment in patients with growth hormone and prolactin co-secreting pituitary adenomas (GH&PRL-PAs). Methods: Acromegaly patients with GH&am...

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Detalles Bibliográficos
Autores: Araujo-Castro, M, Biagetti, B, Menéndez, E, Novoa-Testa, I, Cordido, F, Berrocal, VR, Pascual-Corrales, E, Guerrero-Pérez, F, Vicente, A, García-Centeno, R, Gonzalez, L, Garcia, MDO, Echarri, AI, Rodríguez, MDM, Novo-Rodríguez, C, Calatayud, M, Villar-Taibo, R, Bernabéu, I, Alvarez-Escola, C, Jimenez, CT, Abellan-Galiana, P, Venegas, E, González-Molero, I, Iglesias, P, Blanco, C, De Lara, FVO, Novoa, MPD, Torres, ELM, Hanzu, F, Lamas, C, Rodriguez, SA, Aulinas, A, Recio, JM, Aviles-Pérez, MD, Núñez, MAS, Camara, R, Fano, MP, Fajardo, C, Cardoso, L, Marques, P, Martínez-Sàez, E, Ruz-Caracuel, I, Marazuela, M, Puig-Domingo, M
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2025
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:p20113
Acceso en línea:https://fisabio.portalinvestigacion.com/publicaciones/20113
Access Level:acceso abierto
Palabra clave:acromegaly
somatostatin receptor ligands
surgical remission
growth hormone
prolactin co-secreting pituitary adenoma
Descripción
Sumario:Aim: To evaluate which factors are associated with a higher probability of failure to surgical and first-generation somatostatin receptor ligands (fgSRLs) treatment in patients with growth hormone and prolactin co-secreting pituitary adenomas (GH&PRL-PAs). Methods: Acromegaly patients with GH&PRL-PAs included in the ACRO-SPAIN study were enrolled. GH&PRL-PAs were defined as tumors with serum PRL levels above the upper limit of normal and positive immunostaining for GH and PRL, or with PRL levels >= 100 ng/mL when immunostaining data were not available. Results: A total of 126 acromegaly patients with GH&PRL-PAs who underwent transsphenoidal pituitary surgery were included, and 42.1% (n = 53) were biochemically cured at the immediate postoperative evaluation. Knosp grade >2 (odds ratio (OR) 3.48, 95% CI 1.28-9.38), higher serum GH (OR 1.01, 95% CI 1.01-1.08) and IGF-1 (OR 1.60, 95% CI 1.05-2.45) levels were associated with a lower probability of surgical cure. Sixty-eight patients received first-line medical therapy as follows: fgSRLs in monotherapy (n = 22), fgSRL plus cabergoline (n = 37), cabergoline in monotherapy (n = 7) and pegvisomant in monotherapy (n = 2). Among the cases treated with fgSRL in monotherapy, 18.2% (n = 4/22) were resistant. We identified as predictors of fgSRL resistance (in monotherapy and combined with cabergoline) a Knosp grade >2 (OR 8.75, P = 0.003), high GH levels at acromegaly diagnosis (OR 1.02, P = 0.031) and higher postoperative GH levels (OR 1.05, P = 0.006), but no predictors of response to fgSRL in monotherapy were identified. Conclusion: The clinical predictors of surgical failure and of fgSRL resistance in patients with GH&PRL-PAs are similar to those described in acromegaly without PRL, co-secretion.

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