Differences Between GH- and PRL-Cosecreting and GH-Secreting Pituitary Adenomas: a Series of 604 Cases.
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Araujo-Castro Marta, Biagetti Betina, Menéndez Torre Edelmiro, Novoa-Testa Iría, Cordido Fernando, Pascual Corrales Eider, Rodríguez Berrocal Víctor, Guerrero-Pérez Fernando, Vicente Almudena, Percovich Juan Carlos, García Centeno Rogelio, González Laura, Ollero García María Dolores, Irigaray Echarri Ana, Moure Rodríguez María Dolores, Novo-Rodríguez Cristina, Calatayud María, Villar Rocío, Bernabéu Ignacio, Alvarez-Escola Cristina, Benítez Valderrama Pamela, Tenorio-Jimenéz Carmen, Abellán Galiana Pablo, Venegas Moreno Eva, González Molero Inmaculada, Iglesias Pedro, Blanco Concepción, Vidal-Ostos De Lara Fernando, de Miguel Paz, López Mezquita Elena, Hanzu Felicia, Aldecoa Iban, Lamas Cristina, Aznar Silvia, Aulinas Anna, Calabrese Anna, Gracia Paola, Recio-Córdova José María, Aviles Mariola, Asensio-Wandosel Diego, Sampedro Miguel, Ruz-Caracuel Ignacio, Camara Rosa, Paja Miguel, Fajardo-Montañana Carmen, Marazuela Mónica, Puig-Domingo Manel
Аннотация
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 100 ng/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.