| Objective:Mixed growth hormone(GH)and prolactin(PRL)secreting adenomas are a kind of aggressive and(sometimes)invasive pituitary adenomas.These adenomas encircle approximately 10-30%of all resected adenomas and most commonly immunostaining positively for both GH and PRL.Although there are numerous studies about "false" mixed mammosomatotrophs adenomas that PRL can increase slightly(＜150 ng/ml)due to stalk effect(in the case of large adenoma)and transformation from GH to PRL by alteration of E-cadherin to cadherin 18,clinical characters and epidemiology of true mixed GH-PRL adenomas(PRL>150 ng/ml)have not been yet known clearly,especially in China and other East Asian countries.The purpose of this study was to report the clinical specifications and impacts of TS on true mixed adenoma patients including surgical outcomes,complications,and prognosis to help clinicians choose adequate treatment strategies in the future.Method and patients:Our report studied 12 patients(7 males,5 females)whom all were operated in the neurosurgery department of Qilu hospital affiliated to Shandong University,Shandong,P.R of China.And they would be diagnosed by their clinical features,computed-tomography(CT),magnetic-resonance-imaging(MRI)and hormone levels.We analyzed the difference of hormone levels of preoperation,postoperation(within 24 hours)and follow-up(at the 12th month)and the correlation of hormone levels and tumor volume,the impact of TS on these tumors,postoperative complications and prognosis.Results:results of specifications of the patients,adenomas parameters,hormone levels,complications,and prognosis were collected.There was no statistically significant difference in the age of males and females,(45.8 vs.43.6 years,p=0.73).The remission rate was 66.7%(8/12),the recurrence rate was 16.7%(2/12),the cause-specific mortality rate was 0%and the overall mortality rate was 16.7%(2/12)due to stroke and myocardial infarction respectively.A significant drop was seen in GH,PRL,and Insulin-like-growth-factor-1(IGF-1)levels between preoperation and postoperation with mean values from 52.6 to 9.9 ng/ml(p=0.0015),from 321.6 to 190.9 ng/ml(p=0.0026)and from 815.7 to 230.6 ng/ml(p=0.0004)respectively.Moreover,this drop was more significant in their levels between preoperation and follow-up with mean values from 52.6 to 3.0 ng/ml(p=0.002),from 321.6 to 61.6 ng/ml(p<0.0001),and from 815.7 to 195.0 ng/ml(p=0.0001)respectively.Besides,in consideration of relevance between age and IGF-1 normal range,we also analyzed the fold change of its upper normal range.The average preoperative fold of it was 3.2(range,1.4-7.5)significantly decreased to average 0.9(range,0.4-1.9)postoperatively(p=0.0007)and to average 0.7(range,0.4-1.2)at follow-up(p=0.0002).However,there was no significant correlation between tumor volume and all of the hormone levels including GH(r=-0.1921,95%CI=-0.6899 to 0.4291,p=0.5498),PRL(r=0.3691,95%CI=-0.2599 to 0.7782 p=0.2377),absolute IGF-1(r=-0.2729,95%CI=-0.7322 to 0.3569,p=0.3907)and fold-changeable IGF-1(r=-0.2133,95%CI=-0.7013 to 0.4109,p=0.5057).Conclusion:Most of mixed GH and PRL adenomas are extremely aggressive types of pituitary adenomas due to clinical presentation and management,with a high risk of recurrence and mortality.There were significant connections between hormones levels and clinical features,the patients who had higher GH levels,had dominant clinical features of acromegaly and who had higher PRL levels had dominant clinical features of hyperprolactinemia,therefore we recommend that patients who have clinical features of acromegaly or hyperprolactinemia must be evaluated for the possibilities of both of them.TS is the most appropriate and cost-effective method to treat it with low recurrence and obvious effects on hormone levels,especially for those with long life expectancy.These patients need close follow up and may need chemotherapy and/or radiotherapy as well.This study may be helpful for clinicians to get a deeper understanding of particular characteristics and provide a possible method to diagnose and treat true mixed GH-PRL adenomas. |
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