2026-04-05T12:41:16Zhttps://recercat.cat/oai/requestoai:recercat.cat:11351/139162025-10-24T10:44:56Zcom_2072_378070com_2072_378040col_2072_378092
RECERCAT
author
Novoa-Testa, Iría
author
Cordido, Fernando
author
Rodríguez Berrocal, Víctor
author
Araujo Castro, Marta
author
Biagetti, Betina
author
Menéndez Torre, Edelmiro
author
Martinez-Saez, Elena
2025-10-24T10:44:56Z
2025-10-24T10:44:56Z
2025-10-22T12:23:45Z2025-10-22T12:23:45Z2025-07
http://hdl.handle.net/11351/13916
Growth hormone; Prolactin co-secreting pituitary adenoma; Surgical remissionHormona del creixement; Adenoma hipofisari cosecretor de prolactina; Remissió quirúrgicaHormona del crecimiento; Adenoma hipofisario cosecretor de prolactina; Remisión quirúrgicaAim
To evaluate which factors are associated with a higher probability of failure to surgical and first-generation somatostatin receptor ligands (fgSRLs) treatment in patients with growth hormone and prolactin co-secreting pituitary adenomas (GH&PRL-PAs).
Methods
Acromegaly patients with GH&PRL-PAs included in the ACRO-SPAIN study were enrolled. GH&PRL-PAs were defined as tumors with serum PRL levels above the upper limit of normal and positive immunostaining for GH and PRL, or with PRL levels ≥100 ng/mL when immunostaining data were not available.
Results
A total of 126 acromegaly patients with GH&PRL-PAs who underwent transsphenoidal pituitary surgery were included, and 42.1% (n = 53) were biochemically cured at the immediate postoperative evaluation. Knosp grade >2 (odds ratio (OR) 3.48, 95% CI 1.28–9.38), higher serum GH (OR 1.01, 95% CI 1.01–1.08) and IGF-1 (OR 1.60, 95% CI 1.05–2.45) levels were associated with a lower probability of surgical cure. Sixty-eight patients received first-line medical therapy as follows: fgSRLs in monotherapy (n = 22), fgSRL plus cabergoline (n = 37), cabergoline in monotherapy (n = 7) and pegvisomant in monotherapy (n = 2). Among the cases treated with fgSRL in monotherapy, 18.2% (n = 4/22) were resistant. We identified as predictors of fgSRL resistance (in monotherapy and combined with cabergoline) a Knosp grade >2 (OR 8.75, P = 0.003), high GH levels at acromegaly diagnosis (OR 1.02, P = 0.031) and higher postoperative GH levels (OR 1.05, P = 0.006), but no predictors of response to fgSRL in monotherapy were identified.
Conclusion
The clinical predictors of surgical failure and of fgSRL resistance in patients with GH&PRL-PAs are similar to those described in acromegaly without PRL, co-secretion.
Significance statement
In this article focused on GH&PRL pituitary adenomas, we found that a Knosp grade >2, and higher serum GH and IGF-1 levels were associated with a lower probability of surgical cure in these tumors. Regarding the response to fgSRL in monotherapy, 18% of the patients with GH&PRL pituitary adenomas were classified as resistant. Knosp grade >2 (OR 8.75, P = 0.003), high GH levels at acromegaly diagnosis (OR 1.02, P = 0.031), and higher postoperative GH levels (OR 1.05, P = 0.006) were predictors of non-response to fgSRL (monotherapy or combined with cabergoline), while no predictors of response to fgSRL in monotherapy were identified. Thus, we concluded the clinical predictors of surgical failure and of fgSRL resistance in patients with GH&PRL-PAs are similar to those described in acromegaly without PRL co-secretion.This work was funded by Sociedad Española de Endocrinología y Nutrición (SEEN): ‘Impacto de la co-secreción de prolactina en la expresión de marcadores moleculares y en la respuesta al tratamiento con análogos de somatostatina y agonistas dopaminérgicos en pacientes con acromegalia’.
Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess
Acromegàlia
Hipòfisi - Tumors - Cirurgia
Prolactina
Somatotropina
Adenoma
DISEASES::Neoplasms::Neoplasms by Site::Endocrine Gland Neoplasms::Pituitary Neoplasms
Other subheadings::Other subheadings::Other subheadings::/surgery
DISEASES::Neoplasms::Neoplasms::Neoplasms by Site::Endocrine Gland Neoplasms::Pituitary Neoplasms::Growth Hormone-Secreting Pituitary Adenoma
CHEMICALS AND DRUGS::Hormones, Hormone Substitutes, and Hormone Antagonists::Hormones::Peptide Hormones::Gonadotropins::Gonadotropins, Pituitary::Prolactin
DISEASES::Endocrine System Diseases::Pituitary Diseases::Hyperpituitarism::Acromegaly
ENFERMEDADES::neoplasias::neoplasias por localización::neoplasias de las glándulas endocrinas::neoplasias hipofisarias
Otros calificadores::Otros calificadores::Otros calificadores::/cirugía
ENFERMEDADES::neoplasias::neoplasias::neoplasias por localización::neoplasias de las glándulas endocrinas::neoplasias hipofisarias::adenoma hipofisario secretor de hormona del crecimiento
COMPUESTOS QUÍMICOS Y DROGAS::hormonas, sustitutos de hormonas y antagonistas de hormonas::hormonas::hormonas peptídicas::gonadotropinas::gonadotropinas hipofisarias::prolactina
ENFERMEDADES::enfermedades del sistema endocrino::enfermedades de la hipófisis::hiperpituitarismo::acromegalia
Predictors of therapeutic failure in GH and prolactin co-secreting pituitary adenomas
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion