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