The characteristics of acromegalic patients with hyperprolactinemia and the differences in patients with merely GH-secreting adenomas: clinical analysis of 279 cases

Abstract

Objective: The aim of this study is to evaluate clinical data from a large cohort of acromegalic patients with and without hyperprolactinemia. Design and methods: Between January 2002 and June 2010, a set of data on 279 acromegalic patients undergoing transsphenoidal surgery was available. Based on preoperative GH and prolactin (PRL) levels, patients were divided into GH and GHCPRL groups. A stabilization or a further improvement of postoperative changes in clinical, hormonal, immunohistochemical, and magnetic resonance imaging parameters was observed in all patients throughout the follow-up period. Results: The GH group had significantly more coarse facial features, large hands and feet, hypertension, and diabetes mellitus compared with the GHCPRL group but significantly less menstrual disorders (13.8 vs 54.3%, P!0.001) and galactorrhea (3.1 vs 22.4%, P!0.001). The GH group had a higher age at diagnosis compared with the GHCPRL group (45.6G13.9 vs 40.4G11.4 years, PZ0.001). The GH group had a smaller mean maximal diameter of the adenomas (2.2G0.9 vs 2.6G1.1 cm, PZ0.004). There were no significant correlations between hormone levels and the immunohistochemical results. According to the criteria for hormonal cure of acromegaly, the surgical control rates in the GH and GHCPRL groups were 68.4 and 59.7% respectively (PZ0.187). Tumor size was an important factor that affected the results of the operations. The rates of surgical control in GH and GHCPRL groups were 80.7 and 69.1% respectively (PZ0.037), and the recurrence rates in the two groups were 7.1 and 11.3% respectively (PZ0.185). Conclusions: Compared with patients with merely GH-secreting adenomas, acromegalic patients with hyperprolactinemia are characterized by an earlier onset of disease, lesser acromegalic features, lower GH levels, but larger tumor sizes, whereas in female patients, GH-PRL secreting adenomas are associated with higher incidences of menstrual disorders and galactorrhea.

Menopause and prolactin secreting tumours

“…[11,12] The second case displays the idea of GH control in a newly diagnosed case of macroprolactinoma. [13,14,15] The IGF1 (Insulin Growth Hormone 1) is a screening test in every new case of pituitary adenoma (with reference levels adjusted based on patient' s age and sex). [13,14,15] Since the levels of IGF1 may vary an oral glucose tolerance test is useful especially in tumours larger than 1 cm diameter since acromegaly displays in 80-90 % of cases a macroadenoma.…”

“…[13,14,15] The IGF1 (Insulin Growth Hormone 1) is a screening test in every new case of pituitary adenoma (with reference levels adjusted based on patient' s age and sex). [13,14,15] Since the levels of IGF1 may vary an oral glucose tolerance test is useful especially in tumours larger than 1 cm diameter since acromegaly displays in 80-90 % of cases a macroadenoma. [13,14,15] Prolactin-GH cosecretion is found in one tenth of acromegaly cases with a phenotype suggesting either prolactinoma or acromegaly.…”

“…[13,14,15] Since the levels of IGF1 may vary an oral glucose tolerance test is useful especially in tumours larger than 1 cm diameter since acromegaly displays in 80-90 % of cases a macroadenoma. [13,14,15] Prolactin-GH cosecretion is found in one tenth of acromegaly cases with a phenotype suggesting either prolactinoma or acromegaly. [13,14,15] The case number 2 and 3 were misdiagnosed as menopause and this emphasize the importance of taking at least a FSH test in order to indicate the pituitary or ovarian origin of secondary amenorrhea.…”

“…[13,14,15] Prolactin-GH cosecretion is found in one tenth of acromegaly cases with a phenotype suggesting either prolactinoma or acromegaly. [13,14,15] The case number 2 and 3 were misdiagnosed as menopause and this emphasize the importance of taking at least a FSH test in order to indicate the pituitary or ovarian origin of secondary amenorrhea. Another topic is the period of time that should be recommended between the diagnosis of prolactinoma, the therapy start and a pregnancy.…”

MANAGEMENT OF ENDOCRINE DISEASE: GH excess: diagnosis and medical therapy

“…A recent paper by Wang et al (61) has reported that women with GH-PRL-secreting adenomas often have relatively low serum GH levels and that these adenomas are associated with higher incidences of menstrual disorders and galactorrhoea compared with GH-secreting adenomas. In patients with hyperprolactinaemia, we found that three of 78 patients developed acromegaly (58).…”