A Retrospective Hormonal and Immunohistochemical Evaluation of 47 Acromegalic Patients: Prognostic Value of Preoperative Plasma Prolactin

L. De Marinis; P. Zuppi; D. Valle; A. Mancini; A. Bianchi; L. Lauriola; P. Pasquini; C. Anile; G. Maira; A. Giustina

doi:10.1055/s-2002-23197

Hormone and Metabolic Research, Table of Contents

Horm Metab Res 2002; 34(3): 137-143
DOI: 10.1055/s-2002-23197

Original Clinical

A Retrospective Hormonal and Immunohistochemical Evaluation of 47 Acromegalic Patients: Prognostic Value of Preoperative Plasma Prolactin

L. De Marinis ¹ , P. Zuppi ² , D. Valle ³ , A. Mancini ¹ , A. Bianchi ¹ , L. Lauriola ⁴ , P. Pasquini ⁴ , C. Anile ⁵ , G. Maira ⁵ , A. Giustina ⁶

¹Institute of Endocrinology, Catholic University School of Medicine, Rome, Italy
²Azienda ospedaliera San Camillo - Forlanini, Rome, Italy
³Eli-Lilly, Florence, Italy
⁴Institute of Pathology, Catholic University School of Medicine, Rome, Italy
⁵Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy
⁶Endocrine Section, Department of Internal Medicine, University of Brescia, Italy

Abstract

This study was performed to investigate the correlations between preoperative prolactin (PRL) plasma values, immunohistochemical picture and the clinical course in growth hormone (GH) secreting pituitary adenomas. In 47 patients (19 males and 28 females; mean age 40 years; range 13 - 70 years), we measured GH, IGF-1 and prolactin plasma values both before and after transsphenoidal surgery, and basal IGF-1 and GH after an oral glucose tolerance test (OGTT) during four years of follow-up. We considered those patients as “controlled” who presented an undetectable growth hormone after OGTT (GH < 1 µg/l), IGF-I plasma values in the normal range, matched for age and sex, and no clinical activity or neuroradiological recurrence after a four-year follow-up. We considered patients as “poorly controlled” who still showed elevated GH and IGF-I plasma levels, uninhibited GH after OGTT (GH > 1 µg/l), presence of clinical activity and/or radiological signs of adenoma recurrence, even if a reduction of tumor size had been demonstrated. Results: Controlled patients (n = 22) exhibited mean preoperative PRL levels (± SEM) lower than the group of poorly controlled (n = 25) ones (21.40 ± 5.51 vs. 38.44 ± 5.16 µg/l; p < 0.03). From 3 to 12 months after surgery, postoperative PRL levels were also lower in the controlled patients compared to the poorly controlled ones (8.31 ± 1.20 vs. 25.32 ± 3.20 µg/l; p < 0.0001). Eighty percent (20/25) of poorly controlled patients showed both PRL and GH positivity after immunostaining. Only 3/22 (13.6 %) of controlled patients showed the same double positivity. In conclusion, preoperative hyperprolactinemia identifies a group of acromegalic patients at elevated risk of disease persistence after surgery. We hypothesize that most of these high-risk patients may have more aggressive mixed GH-PRL secreting adenomas.

Key words

Acromegaly - GH - Immunostaining - Prolactin - Pituitary

Full Text

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