Growth hormone and prolactin-staining tumors causing acromegaly: a retrospective review of clinical presentations and surgical outcomes.
Growth hormone and prolactin-staining tumors causing acromegaly: a retrospective review of clinical presentations and surgical outcomes.
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DOI：
10.3171/2018.4.jns18230
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发表时间：
2019-07
影响因子：
4.1
通讯作者：
Jonathan Rick;Arman Jahangiri;P. Flanigan;Ankush Chandra;S. Kunwar;L. Blevins;M. Aghi
中科院分区：
文献类型：
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作者：
Jonathan Rick;Arman Jahangiri;P. Flanigan;Ankush Chandra;S. Kunwar;L. Blevins;M. Aghi
目的肢端肥大症会导致生长畸形和许多医疗并发症。这种疾病通常由分泌生长激素 (GH) 的垂体腺瘤引起，首先通过切除进行治疗，然后根据需要进行放射和/或药物治疗。肢端肥大症患者的一部分患有双染色垂体腺瘤 (DSPA)，可对 GH 和催乳素进行染色。肢端肥大症患者使用 DSPA 的表现和治疗结果尚不清楚。方法作者回顾性回顾了其机构 5 年多的垂体腺瘤切除记录。收集与临床表现、肿瘤病理学、放射学大小和疾病复发相关的变量的数据。使用 Fisher 精确检验、方差分析、Student t 检验、卡方检验、Cox 比例风险和多重逻辑回归来测量统计显着性。 结果 在 593 名垂体腺瘤患者中，91 名出现肢端肥大症。在这 91 名患者中，69 名 (76%) 患有仅 GH 染色的肿瘤（单染生长激素腺瘤 [SSA]），而 22 名 (24%) 患有 GH 和催乳素染色 (DSPA) 的肿瘤。与 SSA 患者相比，DSPA 患者更有可能出现性欲下降 (p = 0.012)、肢端肥大症生长迹象 (p = 0.0001)、多汗症 (p = 0.0001) 和头痛 (p = 0.043)。 DSPA 的血清催乳素水平显着升高（60.7 vs 10.0 µg/L，p = 0.0002）和胰岛素样生长因子-1 (IGF-1)（803.6 vs 480.0 ng/ml，p = 0.0001），并且 IGF-1 水平更有可能 > 650 ng/ml（n = 13 [81.3%] vs n = 6 [21.4%]，p = 0.0001），尽管大小相似（1.8 vs 1.7 cm，p = 0.5），但 SSA 患者的比例却高于 SSA 患者。 35 岁以下的 DSPA 患者比 35 岁以下的 SSA 患者更有可能复发（n = 4 [50.0%] vs n = 3 [11.1%]，p = 0.01）。DSPA 患者比 SSA 患者通过手术获得缓解的可能性更小（n = 2 [20%] vs n = 19 [68%]，p = 0.01）。单变量分析确定单染色肿瘤（p = 0.02）、大体全切除（p = 0.02）和肿瘤直径（p = 0.05）作为手术缓解的预测因子。多元逻辑回归证明 SSA (p = 0.04) 与肢端肥大症的手术缓解独立相关。 Kaplan-Meier 分析显示，DSPA 达到疾病缓解的时间更长 (p = 0.033)。 结论 具有催乳素和 GH 染色的肿瘤的肢端肥大症患者（占该队列中近四分之一的肢端肥大患者）比 SSA 具有更积极的临床表现和术后结果。催乳素染色为接受垂体手术的肢端肥大症患者提供了有用的信息。
OBJECTIVEAcromegaly results in disfiguring growth and numerous medical complications. This disease is typically caused by growth hormone (GH)-secreting pituitary adenomas, which are treated first by resection, followed by radiation and/or medical therapy if needed. A subset of acromegalics have dual-staining pituitary adenomas (DSPAs), which stain for GH and prolactin. Presentations and treatment outcomes for acromegalics with DSPAs are not well understood.METHODSThe authors retrospectively reviewed the records of more than 5 years of pituitary adenomas resected at their institution. Data were collected on variables related to clinical presentation, tumor pathology, radiological size, and disease recurrence. The Fisher's exact test, ANOVA, Student t-test, chi-square test, and Cox proportional hazards and multiple logistic regression were used to measure statistical significance.RESULTSOf 593 patients with pituitary adenoma, 91 presented with acromegaly. Of these 91 patients, 69 (76%) had tumors that stained for GH only (single-staining somatotrophic adenomas [SSAs]), while 22 (24%) had tumors that stained for GH and prolactin (DSPAs). Patients with DSPAs were more likely to present with decreased libido (p = 0.012), signs of acromegalic growth (p = 0.0001), hyperhidrosis (p = 0.0001), and headaches (p = 0.043) than patients with SSAs. DSPAs presented with significantly higher serum prolactin (60.7 vs 10.0 µg/L, p = 0.0002) and insulin-like growth factor-1 (IGF-1) (803.6 vs 480.0 ng/ml, p = 0.0001), and were more likely to have IGF-1 levels > 650 ng/ml (n = 13 [81.3%] vs n = 6 [21.4%], p = 0.0001) than patients with SSAs despite similar sizes (1.8 vs 1.7 cm, p = 0.5). Patients with DSPAs under 35 years of age were more likely to have a recurrence (n = 4 [50.0%] vs n = 3 [11.1%], p = 0.01) than patients with SSAs under the age of 35. DSPA patients were less likely to achieve remission with surgery than SSA patients (n = 2 [20%] vs n = 19 [68%], p = 0.01). Univariate analysis identified single-staining tumors (p = 0.02), gross-total resection (p = 0.02), and tumor diameter (p = 0.05) as predictors of surgical remission. Multiple logistic regression demonstrated that SSAs (p = 0.04) were independently associated with surgical remission of acromegaly. Kaplan-Meier analysis revealed that DSPAs had more time until disease remission (p = 0.033).CONCLUSIONSAcromegalics with tumors that stain for prolactin and GH, which represented almost a quarter of acromegalics in this cohort, had more aggressive clinical presentations and postoperative outcomes than SSAs. Prolactin staining provides useful information for acromegalics undergoing pituitary surgery.