Varlamov Elena V, Wood Matthew D, Netto Joao Prola, Thiessen Jaclyn, Kim Jung, Lim Dawn Shao Ting, Yedinak Christine G, Banskota Swechya, Cetas Justin S, Fleseriu Maria
Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA.
Pituitary. 2020 Dec;23(6):672-680. doi: 10.1007/s11102-020-01075-7.
To investigate demographic, imaging and laboratory characteristics, and treatment outcomes of acromegaly patients who have bihormonal (BA) growth hormone (GH) and prolactin (PRL) immunoreactive adenomas compared to patients who have densely granulated GH adenomas (DGA) and sparsely granulated GH adenomas (SGA).
Retrospective review of single-center surgically treated acromegaly patients; pathology was analyzed by a single neuropathologist using 2017 WHO criteria. Preoperative magnetic resonance imaging was assessed to evaluate tumor size, cystic component, invasion and T2 signal intensity.
Seventy-seven patients; 19 BA (9 mammosomatotroph and 10 mixed GH and PRL adenomas) were compared with 30 DGA, and 28 SGA. Patients with BA were older than SGA (49.6 vs 38.5 years, p = 0.035), had a higher IGF-1 index (3.3 vs 2.3, p = 0.040) and tumors were less frequently invasive (15.8% vs 57.1%, p = 0.005). BA more frequently had a cystic component on MRI than both SGA and DGA (52.6% vs 14.3%, and 22%, p = 0.005 and 0.033, respectively). When all histological types were combined, biochemical remission postoperatively was more common in non-cystic than cystic tumors (50% vs 22.5%, p = 0.042). Somatostatin receptor ligand response rate was 66.7%, 90.9% and 37.5% in BA, DGA and SGA patients, respectively (p = 0.053).
Imaging characteristics are an increasingly important adenoma behavior determinant. An adenoma cystic component may suggest that a GH adenoma is a BA. Cystic tumors exhibited lower rates of surgical remission in this series; therefore, optimized individual patient treatment is needed, as patients could be candidates for primary medical treatment.
研究双激素（BA）生长激素（GH）和催乳素（PRL）免疫反应性腺瘤的肢端肥大症患者与密集颗粒型GH腺瘤（DGA）和稀疏颗粒型GH腺瘤（SGA）患者的人口统计学、影像学和实验室特征以及治疗结果。
对单中心手术治疗的肢端肥大症患者进行回顾性研究；由一名神经病理学家根据2017年世界卫生组织标准分析病理。评估术前磁共振成像以评估肿瘤大小、囊性成分、侵袭情况和T2信号强度。
共77例患者；将19例BA患者（9例乳腺生长激素细胞型和10例混合性GH和PRL腺瘤）与30例DGA患者和28例SGA患者进行比较。BA患者比SGA患者年龄更大（49.6岁对38.5岁，p = 0.035），IGF-1指数更高（3.3对2.3，p = 0.040），且肿瘤侵袭性更少见（15.8%对57.1%，p = 0.005）。BA在MRI上比SGA和DGA更常出现囊性成分（分别为52.6%对14.3%和22%，p = 0.005和0.033）。当所有组织学类型合并时，术后生化缓解在非囊性肿瘤中比囊性肿瘤更常见（50%对22.5%，p = 0.042）。BA、DGA和SGA患者的生长抑素受体配体反应率分别为66.7%、90.9%和37.5%（p = 0.053）。
影像学特征是越来越重要的腺瘤行为决定因素。腺瘤囊性成分可能提示GH腺瘤为BA。在本系列中，囊性肿瘤的手术缓解率较低；因此，需要优化个体化患者治疗，因为患者可能是初始药物治疗的候选者。
