Lee Cheng-Chia, Vance Mary Lee, Lopes M Beatriz, Xu Zhiyuan, Chen Ching-Jen, Sheehan Jason
Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA.
Pituitary. 2015 Jun;18(3):326-34. doi: 10.1007/s11102-014-0578-5.
The subtypes of somatotroph-cell pituitary adenomas have been correlated with clinical and histopathological variables. Densely granulated somatotroph-cell (DG) adenomas are typically highly responsive to somatostatin analog drugs, whereas sparsely granulated somatotroph-cell (SG) are less responsive. The aim of the study is to determine the effect of stereotactic radiosurgery (SRS) on remission and development of new pituitary deficiency according to the different subtypes of growth hormone (GH) secreting adenomas.
A total of 176 patients underwent SRS for acromegaly at the University of Virginia. Diagnosis of acromegaly was based on the combination of clinical features and biochemical assessment including the serum GH level, and age- and gender-matched serum insulin-like growth factor-1 level. All patients underwent endocrine and neuro-imaging evaluations before and after SRS. Histological specimens were available in 73 patients.
The histopathological examination showed 34 patients had a DG adenoma, 19 had a SG adenoma, eight had a mixed DG/SG pattern, while other rare mixed subtypes were present in 12 patients. Patients who had a SG adenoma were more likely to be younger and female, and the SG adenomas appeared to be more invasive into the cavernous sinus. With a median follow-up of 67 months (range 6-188 months), 55/73 patients (75.3%) achieved remission. The median time to remission was 26 months (range 6-102 months). The actuarial remission rates in the DG adenoma group at 2, 4, and 6 years post-radiosurgery were 35.1, 71.4, and 79.3%, respectively, while those in SG adenoma group were 35.4, 73.1, and 82.1%, respectively.
While patients who had a SG adenoma may be less responsive to medical therapy, they exhibited similar responses to SRS as patients with a DG adenoma. For SG adenomas, which respond less well to medical therapy, earlier SRS may be reasonable for consideration.
生长激素细胞垂体腺瘤的亚型已与临床和组织病理学变量相关联。密集颗粒型生长激素细胞（DG）腺瘤通常对生长抑素类似物药物高度敏感，而稀疏颗粒型生长激素细胞（SG）腺瘤则反应较差。本研究的目的是根据分泌生长激素（GH）腺瘤的不同亚型，确定立体定向放射外科（SRS）对缓解及新的垂体功能减退发生的影响。
弗吉尼亚大学共有176例肢端肥大症患者接受了SRS治疗。肢端肥大症的诊断基于临床特征和生化评估的结合，包括血清GH水平以及年龄和性别匹配的血清胰岛素样生长因子-1水平。所有患者在SRS前后均接受了内分泌和神经影像学评估。73例患者有组织学标本。
组织病理学检查显示，34例患者为DG腺瘤，19例为SG腺瘤，8例为DG/SG混合模式，12例患者存在其他罕见的混合亚型。患有SG腺瘤的患者更可能较年轻且为女性，并且SG腺瘤似乎更易侵犯海绵窦。中位随访时间为67个月（范围6 - 188个月），55/73例患者（75.3%）实现缓解。缓解的中位时间为26个月（范围6 - 102个月）。放射外科治疗后2年、4年和6年，DG腺瘤组的精算缓解率分别为35.1%、71.4%和79.3%，而SG腺瘤组分别为35.4%、73.1%和82.1%。
虽然患有SG腺瘤的患者可能对药物治疗反应较差，但他们对SRS的反应与DG腺瘤患者相似。对于药物治疗反应欠佳的SG腺瘤，早期SRS可能是合理的考虑选择。
