Predictors of therapeutic failure in GH and prolactin co-secreting pituitary adenomas
Araujo-Castro, Marta (Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS))
Biagetti, Betina (Hospital Universitari Vall d'Hebron)
Menéndez Torre, E. (Instituto de Investigación Sanitaria del Principado de Asturias)
Cordido, Fernando (Hospital Universitario A Coruña & Universidad de A Coruña)
Pascual-Corrales, Eider (Hospital Universitario de Cruces (Barakaldo, País Basc))
Guerrero-Pérez, Fernando (Hospital Universitari de Bellvitge)
Vicente, Almudena (Hospital Universitario de Toledo)
García-Centeno, Rogelio (Hospital General Universitario Gregorio Marañón)
González, Laura (Hospital General Universitario Gregorio Marañón)
Echarri, Ana Irigaray (Hospital Universitario Navarra)
Novo-Rodríguez, Cristina (Hospital Universitario Virgen de las Nieves (Granada))
Calatayud, María (Hospital Universitario 12 de Octubre (Madrid))
Villar-Taibo, Rocío (Hospital Clínico Universitario (Santiago de Compostela, Galícia))
Bernabeu Morón, Ignacio (Hospital Clínico Universitario (Santiago de Compostela, Galícia))
Alvarez-Escola, Cristina (Hospital Universitario La Paz (Madrid))
Abellán-Galiana, Pablo (Universidad Cardenal Herrera-CEU. CEU Universities)
Venegas, Eva (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
González-Molero, Inmaculada (Hospital Regional Universitario de Málaga)
Iglesias, Pedro (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Blanco, Concepción (Hospital Universitario Príncipe de Asturias (Alcalá de Henares, Madrid))
Lamas, Cristina (Complejo Hospitalario Universitario de Albacete)
Aulinas, Anna (Institut de Recerca Sant Pau)
Camara, Rosa (Hospital Universitari i Politècnic La Fe (València))
Fajardo-Montañana, Carmen (Hospital Universitario La Ribera)
Cardoso, Luís (Coimbra Institute for Biomedical Imaging and Translational Research)
Martinez-Saez, Elena (Hospital Universitari Vall d'Hebron)
Ruz-Caracuel, Ignacio (Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS))
Marazuela, Mónica (Hospital Universitario La Princesa Madrid)
Puig Domingo, Manuel (CIBERER group 747)
Novoa-Testa, Iria (Hospital Universitario A Coruña & Universidad de A Coruña)
Rodríguez Berrocal, Víctor (Hospital Universitario Ramón y Cajal (Madrid))
Ollero García, María Dolores (Hospital Universitario Navarra)
Moure Rodríguez, María Dolores (Hospital Universitario de Cruces (Barakaldo, País Basc))
Tenorio Jiménez, Carmen (Hospital Universitario Virgen de las Nieves (Granada))
Vidal-Ostos De Lara, Fernando (Hospital Universitario Príncipe de Asturias (Alcalá de Henares, Madrid))
de Miguel Novoa, María Paz (Hospital Clínico San Carlos (Madrid))
López Mezquita Torres, Elena (Hospital Universitario San Cecilio (Granada))
Hanzu, Felicia A. (Hospital Clínic i Provincial de Barcelona)
Aznar Rodríguez, Silvia (Complejo Hospitalario Universitario de Albacete)
Recio-Córdova, José María (Hospital Universitario de Salamanca)
Avilés-Pérez, María Dolores (Hospital Universitario San Cecilio (Granada))
Sampedro Núñez, Miguel Antonio (Hospital Universitario La Princesa Madrid)
Paja Fano, Miguel (Universidad del País Vasco)
Marques, Pedro (Universidade Católica Portuguesa)
Universitat Autònoma de Barcelona. Departament de Medicina

Data:	2025
Resum:	Aim: 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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Acromegaly ; Growth hormone ; Prolactin co-secreting pituitary adenoma ; Somatostatin receptor ligands ; Surgical remission
Publicat a:	Endocrine Connections, Vol. 14, Num. 7 (July 2025) , art. e250103, ISSN 2049-3614

DOI: 10.1530/EC-25-0103
PMID: 40590355

11 p, 424.2 KB

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