Endocrinology & Nutrition Department, Hospital Universitario Vall de Hebrón, CIBERER U747 (ISCIII), ENDO-ERN, Barcelona, PC 08032, Spain.
Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, PC 28034, Spain.
Eur J Endocrinol. 2024 Jun 5;190(6):458-466. doi: 10.1093/ejendo/lvae053.
The aim of this study is to compare the response to first-line medical treatment in treatment-naive acromegaly patients with pure growth hormone (GH)-secreting pituitary adenoma (GH-PA) and those with GH and prolactin cosecreting PA (GH&PRL-PA).
This is a retrospective multicentric study of acromegaly patients followed from 2003 to 2023 in 33 tertiary Spanish hospitals with at least 6 months of first-line medical treatment.
Baseline characteristics, first-line medical treatment strategies, and outcomes were analyzed. We employed a multiple logistic regression full model to estimate the impact of some baseline characteristics on disease control after each treatment modality.
Of the 144 patients included, 72.9% had a GH-PA, and 27.1% had a GH&PRL-PA. Patients with GH&PRL-PA were younger (43.9 ± 15.0 vs 51.9 ± 12.7 years, P < .01) and harboring more frequently macroadenomas (89.7% vs 72.1%, P = .03). First-generation somatostatin receptor ligand (fgSRL) as monotherapy was given to 106 (73.6%) and a combination treatment with fgSRL and cabergoline in the remaining 38 (26.4%). Patients with GH&PRL-PA received more frequently a combination therapy (56.4% vs 15.2%, P < .01). After 6 months of treatment, in the group of patients under fgSRL as monotherapy, those patients with GH&PRL-PA had worse control compared to GH-PAs (29.4% vs 55.1%, P = .04). However, these differences in the rate of disease control between both groups disappeared when both received combination treatment with fgSRL and cabergoline.
In GH&PRL-PA, the biochemical control achieved with fgSRL as monotherapy is substantially worse than in patients harboring GH-PA, supporting the inclusion of cabergoline as first-line medical treatment in combination with fgSRLs in these subgroups of patients.
本研究旨在比较初治生长激素（GH）分泌型垂体腺瘤（GH-PA）和 GH 与泌乳素共分泌型垂体腺瘤（GH&PRL-PA）的初治患者对一线治疗的反应。
这是一项回顾性多中心研究，纳入了 2003 年至 2023 年在西班牙 33 家三级医院接受至少 6 个月一线药物治疗的肢端肥大症患者。
分析了基线特征、一线药物治疗策略和结局。我们采用多因素逻辑回归全模型来估计每种治疗方式后某些基线特征对疾病控制的影响。
144 例患者中，72.9%为 GH-PA，27.1%为 GH&PRL-PA。GH&PRL-PA 患者更年轻（43.9±15.0 岁 vs. 51.9±12.7 岁，P＜0.01），且更常为大腺瘤（89.7% vs. 72.1%，P=0.03）。106 例（73.6%）患者接受第一代生长抑素受体配体（fgSRL）单药治疗，其余 38 例（26.4%）患者接受 fgSRL 联合卡麦角林联合治疗。GH&PRL-PA 患者更常接受联合治疗（56.4% vs. 15.2%，P＜0.01）。在 fgSRL 单药治疗的患者中，接受 GH&PRL-PA 治疗的患者治疗 6 个月后的控制率较 GH-PA 患者差（29.4% vs. 55.1%，P=0.04）。然而，当两组均接受 fgSRL 和卡麦角林联合治疗时，两组间疾病控制率的差异消失。
在 GH&PRL-PA 中，FG-SRL 单药治疗的生化控制明显差于 GH-PA 患者，支持在这些患者亚组中纳入卡麦角林作为 FG-SRL 联合一线治疗。
