The characteristics of acromegalic patients with hyperprolactinemia and the differences in patients with merely GH-secreting adenomas: clinical analysis of 279 cases.
The characteristics of acromegalic patients with hyperprolactinemia and the differences in patients with merely GH-secreting adenomas: clinical analysis of 279 cases.
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DOI：
10.1530/eje-11-1119
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发表时间：
2012-05
影响因子：
5.8
通讯作者：
Min Wang;Chengzhi Mou;Meng Jiang;Lizhang Han;Shengqiang Fan;C. Huan;Xin Qu;T. Han;Yuanming Qu;Guang-Ming Xu
中科院分区：
文献类型：
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作者：
Min Wang;Chengzhi Mou;Meng Jiang;Lizhang Han;Shengqiang Fan;C. Huan;Xin Qu;T. Han;Yuanming Qu;Guang-Ming Xu
目的：本研究的目的是评估一个大型队列的肢端肥大症患者伴或不伴高催乳素血症的临床资料。设计与方法：2002年1月至2010年6月，收集了279例接受经蝶手术的肢端肥大症患者的数据。根据术前GH和催乳素（PRL）水平，将患者分为GH组和GH+PRL组。在整个随访期间，观察到所有患者的临床、激素、免疫组化和磁共振成像参数的术后变化稳定或进一步改善。结果GH组面部粗糙、手足粗大、高血压、糖尿病的发生率明显高于GH+PRL组，而月经紊乱（13.8vs54.3%，P<0.001）、泌乳过多（3.1vs22.4%，P<0.001）的发生率明显低于GH + PRL组。GH组的诊断年龄高于GH+PRL组（45.6 ± 13.9岁vs 40.4 ± 11.4岁，P=0.001）。GH组腺瘤的平均最大直径较小（2.2 ± 0.9 vs 2.6 ± 1.1 cm，P=0.004）。激素水平与免疫组化结果之间无显著相关性。根据激素治疗肢端肥大症的标准，GH组和GH+PRL组的手术控制率分别为68.4%和59.7%（P=0.187）。肿瘤大小是影响手术效果的重要因素。GH组和GH+PRL组的手术控制率分别为80.7%和69.1%（P=0.037），复发率分别为7.1%和11.3%（P=0.185）。结论：与仅患有GH分泌腺瘤的患者相比，伴有高催乳素血症的肢端肥大症患者的特点是发病较早、肢端肥大症特征较少、GH水平较低，但肿瘤尺寸较大，而在女性患者中，GH-PRL分泌腺瘤与月经失调和溢乳的发生率较高相关。
OBJECTIVE The aim of this study is to evaluate clinical data from a large cohort of acromegalic patients with and without hyperprolactinemia. DESIGN AND METHODS Between January 2002 and June 2010, a set of data on 279 acromegalic patients undergoing transsphenoidal surgery was available. Based on preoperative GH and prolactin (PRL) levels, patients were divided into GH and GH+PRL groups. A stabilization or a further improvement of postoperative changes in clinical, hormonal, immunohistochemical, and magnetic resonance imaging parameters was observed in all patients throughout the follow-up period. RESULTS The GH group had significantly more coarse facial features, large hands and feet, hypertension, and diabetes mellitus compared with the GH+PRL group but significantly less menstrual disorders (13.8 vs 54.3%, P<0.001) and galactorrhea (3.1 vs 22.4%, P<0.001). The GH group had a higher age at diagnosis compared with the GH+PRL group (45.6 ± 13.9 vs 40.4 ± 11.4 years, P=0.001). The GH group had a smaller mean maximal diameter of the adenomas (2.2 ± 0.9 vs 2.6 ± 1.1 cm, P=0.004). There were no significant correlations between hormone levels and the immunohistochemical results. According to the criteria for hormonal cure of acromegaly, the surgical control rates in the GH and GH+PRL groups were 68.4 and 59.7% respectively (P=0.187). Tumor size was an important factor that affected the results of the operations. The rates of surgical control in GH and GH+PRL groups were 80.7 and 69.1% respectively (P=0.037), and the recurrence rates in the two groups were 7.1 and 11.3% respectively (P=0.185). CONCLUSIONS Compared with patients with merely GH-secreting adenomas, acromegalic patients with hyperprolactinemia are characterized by an earlier onset of disease, lesser acromegalic features, lower GH levels, but larger tumor sizes, whereas in female patients, GH-PRL secreting adenomas are associated with higher incidences of menstrual disorders and galactorrhea.