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

Fecha de publicación: 04/03/2024 Fecha Ahead of Print: 01/03/2024

Autores de IIS La Fe

Rosa Cámara Gómez

Autor

Participantes ajenos a IIS La Fe

Araujo-Castro, Marta
Biagetti, Betina
Menendez Torre, Edelmiro
Novoa-Testa, Iria
Cordido, Fernando
Pascual Corrales, Eider
Rodriguez Berrocal, Victor
Guerrero-Perez, Fernando
Vicente, Almudena
Percovich, Juan Carlos
Garcia Centeno, Rogelio
Gonzalez, Laura
Ollero Garcia, Maria Dolores
Irigaray Echarri, Ana
Moure Rodriguez, Maria Dolores
Novo-Rodriguez, Cristina
Calatayud, Maria
Villar, Rocio
Bernabeu, Ignacio
Alvarez-Escola, Cristina
Benitez Valderrama, Pamela
Tenorio-Jimenez, Carmen
Abellan Galiana, Pablo
Venegas Moreno, Eva
Gonzalez Molero, Inmaculada
Iglesias, Pedro
Blanco, Concepcion
Vidal-Ostos De Lara, Fernando
de Miguel, Paz
Lopez Mezquita, Elena
Hanzu, Felicia
Aldecoa, Iban
Lamas, Cristina
Aznar, Silvia
Aulinas, Anna
Calabrese, Anna
Gracia, Paola
Recio-Cordova, Jose Maria
Aviles, Mariola
Asensio-Wandosel, Diego
Sampedro, Miguel
Ruz-Caracuel, Ignacio
Paja, Miguel
Fajardo-Montanana, Carmen
Marazuela, Monica
Puig-Domingo, Manel

Grupos

Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética clínica

Leader

Juan Francisco Merino Torres

Abstract

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.