| ObjectiveTo summarize and analyze the clinical features in hospitalized patients with growth-hormone adenoma (GA) during the past 27 years and GA patients with different glucose metabolism status.Methods1. All data of patients with GA admitted to PLA general hospital since 1990.01 to 2016.12 were collected. The sex ratio, visiting ages, the year of hospitalization,laboratory tests and auxiliary examinations results, therapeutic methods and prognosis were retrospectively analyzed.2. Among all included cases, we studied 106 GA patients with different glucose metabolism status. The clinical features and laboratory tests results were retrospectively analyzed.Results1. (1) The hospitalized GA patients have showed an upward trend since 1990. In particular, patients admitted in recent 3 years account for 56.2%; (2) The sex ratio for GA patients is nearly 1 : 1;Age of GA patients follow Gaussian distribution while the 41-50 age group has the largest number; (3) The most typical sign is somatic enlargement (60.7%) followed by the hypertrophy of nasal ala; The most common symptoms are headache (42.5%) and hypopsia, visual field defect and diplopia; (4) More than half of GA patients are complicated with prediabetes and diabetes (72.6%) , sleep apnea (69.5%) , goiter or thyroid nodularity (56.4%),cardiac insufficiency (57%) and colon polyp (54.1 %) while less than half have undergone the relevant examination such as 75g OGTT test, polysomnography,thyroid ultrasound,echocardiogram and colonoscopy( 42.1%,23.4%,37.3%, 47.6%and 14.7%) ; (5) GH is 23.37±1.42 ?g/L and IGF-1 is 804.28±273.93ng/mL on average; (6) 85% of somatotroph tumor are macroadenomas; (7) Surgery remains the mainstay of therapy to GA, resulting in an initial remission rate of 52.7%, while medical therapy is selected by less patients; During the follow-up, only 38% of GA patients can be contacted, among whom the remission rate drop to 40.5%; (8) The positive rate of early postoperative GH level used to evaluate the effectiveness of surgery was consistent with that of remission after surgery during the long-term follow-up (X2=3.368, P>0.05 ).2. (1) Glucose metabolism status of a total of 106 among 252 GA patients was in awareness; 62 GA patients was complicated with diabetes mellitus (DM) , 15 with prediabets (PreDM) and 29 with normal glucose tolerance (NGT) ; (2) There existed significant differences between GA patients with DM, PreDM, and NGT in the positive rate of skin tags, lips pachynsis and very tall statures (X2=6.124,P=0.047; X2=13.029, P=0.001 ; X2=6.036, P=0.049); The subgroup analysis showed a statistically lower positive rate in DM group in skin tags, comparing with NGT group (X2=4.188, P=0.041) whereas in DM and PreDM group in lips pachynsis(X2=11.746, P=0.001; X2=8.667, P=0.003) ; And the subgroup analysis showed another statistically lower positive rates in DM group in very tall statures,comparing with PreDM and NGT group(X2=5.645, P=0.018; X2=4.431,P=0.035);Although no significant differences in the hypertrophy of nasal ala and macroglossia could be detected,the subgroup analysis showed statistically lower positive rates in PreDM group in he hypertrophy of nasal ala, comparing with NGT group (X2=4.364, P=0.037) as well as in macroglossia, comparing with DM and NGT group (X2=4.507, P=0.034: X2=5.057, P=0.025) ; (3) There existed a significant difference between GA patients with DM, PreDM, and NGT in the positive rate of fatigue or lethargy (X2=6.467, P=0.011); While the subgroup analysis showed a statistically lower positive rate in DM group, comparing with NGT group (X2=6.467, P=0.011); There existed another significant difference between GA patients in 3 groups in the positive rate of arthralgia(X2=6.467,P=0.011); While the subgroup analysis showed a same statistically lower positive rate in DM group,comparing with PreDM (X2=6.547,P=0.011) and NGT group(X2=3.881, P=0.049); (4) There existed no significant differences between GA patients in 3 groups in the positive rate of any comorbidities; While the subgroup(?)analysis showed a statistically higher positive rate of goiter or thyroid nodularity in DM group,comparing with NGT group (X2=5.013,P=0.025); (5) The average age of GA patients in DM group was older than that in NGT group (47.19± 10.05vs.41.07±13.19, P<0.05); (5)GA patients in NGT group had a higher serum creatine kinase level than those in PreDM and DM group (106.55vs.90.00?106.55vs.80.90,P<0.05) but a lower serum Y -GT level and triglyceride than those in DM group(11.25vs. 15.30?1.08vs. 1.42,P<0.05) as well as a lower serum phosphorus level than those in PreDM(1.63±0.28vs. 1.47±0.24, P<0.05); (7)According to thyroid hormones, DM group showed a obvious decrease in TSH when comparing with NGT group (0.99vs.1.33, P<0.05) ; While PreDM group showed a sharp increase in TT3 when comparing with other 2 groups(DM: 1.81vs.1.68?PreDM:1.81vs1.61,P<0.05) ; (8) Compared with GA patients in NGT group, higher serum ACTH and cortisol level existed among GA patients with DM (9.64±5.81vs. 6.66±3.49?363.75± 137.76vs.278.69± 148.27, P<0.05); (9)Despite of the same serum IGF-1 level, adenoma size and the IGF-1/GH ratio, GA patients with PreDM had a significantly higher serum GH level than those with NGT (22.40vs.11.10, P<0.05).Conclusion1. The number of patients with GA gradually has being soared in recent 9 years.2. There are common specific physical signs such as somatic enlargement and nonspecific symptoms such as headache among GA patients.3. Due to uncompleted screening, GA associated comorbidities are always misdiagnosed.4. Early postoperative GH levels may predict the prognosis of surgery.5. It is essential to establish a sound model of follow-up to improve patients' quality of life.6. Differences can be seen in clinical symptoms, signs and comorbidities among GA patients with and without normal glucose metabolism; While the latter seem to be more likely to suffer from goiter or thyroid nodularity but less likely to have a very tall stature.7. Because of the existence of GA and DM , patients' function of hypothalamus-pituitary-thyroid/adrenal may change; While DM may play a more critical role.8. The main factors of glucose metabolism disorder in GA patients may involve age and serum GH level. |
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