Differences between GH- and PRL-cosecreting and GH-secreting pituitary adenomas: a series of 604 cases

Araújo-Castro, MartaBiagetti, BetinaMenéndez-Torre, Edelmiro LuisNovoa-Testa, IriaCordido, FernandoPascual-Corrales, EiderRodríguez-Berrocal, VíctorGuerrero-Pérez, FernandoVicente, AlmudenaPercovich, Juan CarlosGarcía-Centeno, RogelioGonzález-Fernández, LauraOllero García-Agulló, María DoloresIrigaray Echarri, AnaMoure Rodríguez, María DoloresNovo-Rodríguez, CristinaCalatayud, MaríaVillar-Taibo, RocíoBernabeu Morón, IgnacioÁlvarez-Escola, MaríaBenítez Valderrama, PamelaTenorio-Jiménez, CarmenAbellán Galiana, PabloVenegas Moreno, EvaGonzález-Molero, InmaculadaIglesias, PedroBlanco-Carrera, ConcepciónVidal-Ostos De Lara, Fernandode Miguel, PazLópez Mezquita, ElenaHanzu, Felicia AlexandraAldecoa, IbanLamas, CristinaAznar, SilviaAulinas, AnnaCalabrese, AnnaGracia, PaolaRecio-Córdova, José MaríaAvilés-Pérez, María DoloresAsensio-Wandosel, DiegoSampedro-Núñez, MiguelRuz-Caracuel, IgnacioCámara, RosaPaja Fano, MiguelFajardo-Montañana, CarmenMarazuela, MónicaPuig-Domingo, Manuel2025-02-182024-03-04Araujo-Castro M, Biagetti B, Menéndez Torre E, Novoa-Testa I, Cordido F, Pascual Corrales E, Rodríguez Berrocal V, Guerrero-Pérez F, Vicente A, Percovich JC, García Centeno R, González L, Ollero García MD, Irigaray Echarri A, Moure Rodríguez MD, Novo-Rodríguez C, Calatayud M, Villar R, Bernabéu I, Alvarez-Escola C, Benítez Valderrama P, Tenorio-Jimenéz C, Abellán Galiana P, Venegas Moreno E, González Molero I, Iglesias P, Blanco C, Vidal-Ostos De Lara F, de Miguel P, López Mezquita E, 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. Differences between GH- and PRL-cosecreting and GH-secreting pituitary adenomas: a series of 604 cases. J Clin Endocrinol Metab. 2024 Nov 18;109(12):e2178-e21870021-972Xhttp://hdl.handle.net/2183/41202Multicenter study[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.engAcromegalyMixed tumorsPituitary adenomaProlactinSurgical remissionDifferences between GH- and PRL-cosecreting and GH-secreting pituitary adenomas: a series of 604 casesjournal articleopen access10.1210/clinem/dgae126