Vantyghem M C, Cortet C, Bauters C, Gevaert M H, Dewailly D, Lefebvre J, Mazzucca M
Service d'Endocrinologie et Maladies Métaboliques, Clinique Marc Linquette, USN-A, CHRU, Lille, France.
J Endocrinol Invest. 1998 Jul-Aug;21(7):434-40. doi: 10.1007/BF03347322.
Glycoprotein hormone alpha subunit (alpha SU) is expressed in nearly all thyreotroph adenomas and most gonadotrophinomas, but is less well documented in plurisecreting adenomas. We therefore examined the immunohistochemical (IHC) expression of alpha SU in a generally accepted model of plurisecreting adenomas (somatoprolactinic type) by comparison to a series of pure monosecreting somatotroph tumors. Fifty patients (32 females, 18 males) aged 15 to 68 years with clinical and/or biological acromegaly requiring adenomectomy were studied. Forty-five had clinical acromegaly and 5 had isolated amenorrhea and/or galactorrhea syndromes. Forty-eight of the 49 patients who had baseline assessments of plasma GH had a mean concentration of 5 ng/ml or more (normal value < 5). Fifteen of the 46 patients who had baseline measurements of plasma PRL had a prolactinemia value greater than 20 ng/ml (normal value < 20) but below 100 ng/ml, except for one patient. All the adenomas studied were positive by GH immunohistochemistry; 21 were immunostained by an antiPRL antibody and formed the "somatoprolactinic" (GH-PRL) group. Five of these 21 patients were male. The 12 female patients younger than 50 years had amenorrhea or galactorrhea, and one male patient complained of impotence. Eleven patients (9 females, 2 males) in this GH-PRL group had hyperprolactinemia. Sixteen of these GH-PRL adenomas were immunolabeled by alpha SU antiserum. The remaining 29 adenomas, which were immunonegative with the PRL antibody and formed the "somatotroph adenoma" (GH) group, were more frequent in male patients (13/29; 45%) compared to GH-PRL group. Eight amenorrhea or galactorrhea syndromes occurred among the 14 women younger than 50 years, 3 of whom had hyperprolactinemia. Thirteen of these 29 adenomas (45%) were immunopositive with alpha SU antibody. Compared to the GH group, the GH-PRL group had a significant higher frequency of amenorrhea and/or galactorrhea syndromes among women under 50 years (100% vs 57%; p < 0.01), as well as hyperprolactinemia (55% vs 15%; p < 0.01) and positive alpha SU immunoreactivity (76% vs 45%; p < 0.05). The frequency of extrasellar macroadenomas was not different according to PRL or alpha SU immunoreactivity. Thus, in this series of somatoprolactinic adenomas, alpha SU immunopositivity was slightly more frequent than in a control group of pure somatotroph adenomas. Moreover, hyperprolactinemia was more frequent in patients with GH-PRL adenomas, although the size of the pure and mixed adenomas was not different. These results suggest that hyperprolactinemia and/or alpha SU immunopositivity are more often associated with mixed GH-PRL adenomas.
糖蛋白激素α亚基（αSU）在几乎所有促甲状腺激素腺瘤和大多数促性腺激素腺瘤中均有表达，但在多分泌性腺瘤中的相关记录较少。因此，我们通过与一系列单纯分泌生长激素的肿瘤进行比较，研究了αSU在一种普遍认可的多分泌性腺瘤（生长激素-泌乳素型）模型中的免疫组化（IHC）表达。研究对象为50例年龄在15至68岁之间、患有临床和/或生物学上的肢端肥大症且需要进行腺瘤切除术的患者（32例女性，18例男性）。45例有临床肢端肥大症，5例有孤立性闭经和/或溢乳综合征。在49例进行了血浆生长激素基线评估的患者中，48例的平均浓度为5 ng/ml或更高（正常值<5）。在46例进行了血浆泌乳素基线测量的患者中，15例的泌乳素血症值大于20 ng/ml（正常值<20）但低于100 ng/ml，除1例患者外。所有研究的腺瘤通过生长激素免疫组化均呈阳性；21例被抗泌乳素抗体免疫染色，形成“生长激素-泌乳素型”（GH-PRL）组。这21例患者中有5例为男性。12例年龄小于50岁的女性患者有闭经或溢乳，1例男性患者主诉阳痿。该GH-PRL组中的11例患者（9例女性,2例男性）有高泌乳素血症。这些GH-PRL腺瘤中有16例被αSU抗血清免疫标记。其余29例腺瘤对泌乳素抗体免疫阴性，形成“生长激素腺瘤”（GH）组，与GH-PRL组相比，在男性患者中更常见（13/29；45%）。14例年龄小于50岁的女性中有8例出现闭经或溢乳综合征，其中3例有高泌乳素血症。这29例腺瘤中有13例（45%）对αSU抗体免疫阳性。与GH组相比，GH-PRL组在50岁以下女性中闭经和/或溢乳综合征的发生率显著更高（100%对57%；p<0.01），高泌乳素血症的发生率也更高（55%对1%;p<0.01），αSU免疫反应阳性率也更高（76%对45%；p<0.05）。根据泌乳素或αSU免疫反应性，鞍外大腺瘤的发生率没有差异。因此，在这一系列生长激素-泌乳素型腺瘤中，αSU免疫阳性比单纯生长激素腺瘤的对照组略为常见。此外，GH-PRL腺瘤患者中高泌乳素血症更常见，尽管单纯腺瘤和混合腺瘤的大小没有差异。这些结果表明，高泌乳素血症和/或αSU免疫阳性更常与混合性GH-PRL腺瘤相关。
