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Araujo-Castro M, Biagetti B, Menéndez Torre E, Novoa-Testa I, Cordido F, Pascual Corrales E, Rodríguez Berrocal V, Guerrero-Pérez F, Vicente A, Percovich JC, García Centeno R, González L, Ollero García MD, Irigaray Echarri A, Moure Rodríguez MD, Novo-Rodríguez C, Calatayud M, Villar R, Bernabéu I, Alvarez-Escola C, Benítez Valderrama P, Tenorio-Jimenéz C, Abellán Galiana P, Venegas Moreno E, González Molero I, Iglesias P, Blanco C, Vidal-Ostos De Lara F, de Miguel P, López Mezquita E, Hanzu F, Aldecoa I, Lamas C, Aznar S, Aulinas A, Calabrese A, Gracia P, Recio-Córdova JM, Aviles M, Asensio-Wandosel D, Sampedro M, Ruz-Caracuel I, Camara R, Paja M, Fajardo-Montañana C, Marazuela M, Puig-Domingo M. Differences between GH and PRL co-secreting and GH-secreting pituitary adenomas. A series of 604 cases. J Clin Endocrinol Metab 2024:dgae126. [PMID: 38436926 DOI: 10.1210/clinem/dgae126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To evaluate differences in clinical presentation and in surgical outcomes between growth hormone-secreting pituitary adenomas (GH-PAs) and GH and prolactin co-secreting pituitary adenomas (GH&PRL-PAs). METHODS Multicenter retrospective study of 604 patients with acromegaly submitted to pituitary surgery. Patients were classified into two groups according to serum PRL levels at diagnosis and immunohistochemistry (IHC) for PRL: a) GH&PRL-PAs when PRL levels were above the upper limit of normal and IHC for GH and PRL was positive or PRL levels were >100ng/and PRL IHC was not available (n=130) and b) GH-PAs who did not meet the previously mentioned criteria (n=474). RESULTS GH&PRL-PAs represented 21.5% (n=130) of patients with acromegaly. The mean age at diagnosis was lower in GH&PRL-PAs than in GH-PAs (P<0.001). GH&PRL-PAs were more frequently macroadenomas (90.6% vs. 77.4%, P=0.001) and tended to be more invasive (33.6% vs. 24.7%, P=0.057) than GH-PAs. Furthermore, they had presurgical hypopituitarism more frequently (OR 2.8, 95% CI 1.83-4.38). IGF-1 upper limit of normality (ULN) levels at diagnosis were lower in patients with GH&PRL-PAs (median 2.4 [IQR 1.73-3.29] vs. 2.7 [IQR 1.91-3.67], P=0.023). There were no differences in the immediate (41.1% vs 43.3%, P=0.659) or long-term post-surgical acromegaly biochemical cure rate (53.5% vs. 53.1%, P=0.936) between groups. However, there was a higher incidence of permanent arginine-vasopressin deficiency (AVP-D) (7.3% vs. 2.4%, P=0.011) in GH&PRL-PAs patients. CONCLUSIONS GH&PRL-PAs are responsible for 20% of acromegaly cases. These tumors are more invasive, larger and cause hypopituitarism more frequently than GH-PAs and are diagnosed at an earlier age. The biochemical cure rate is similar between both groups, but patients with GH&PRL-PAs tend to develop permanent postsurgical AVP-D more frequently.
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Affiliation(s)
- Marta Araujo-Castro
- Endocrinology & Nutrition Department. Hospital Universitario Ramón y Cajal. Madrid, Spain & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS)
| | - Betina Biagetti
- Endocrinology & Nutrition Department. Hospital Universitario Vall de Hebrón. Barcelona, Spain
| | - Edelmiro Menéndez Torre
- Endocrinology & Nutrition Department. Hospital Universitario Central de Asturias. Asturias, Spain & Instituto de Investigación Sanitaria del Principado de Asturias (ISPA)
| | - Iría Novoa-Testa
- Endocrinology & Nutrition Department. Hospital Universitario de Coruña. Coruña, Spain
| | - Fernando Cordido
- Endocrinology & Nutrition Department. Hospital Universitario de Coruña. Coruña, Spain
| | - Eider Pascual Corrales
- Endocrinology & Nutrition Department. Hospital Universitario Ramón y Cajal. Madrid, Spain & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS)
| | | | - Fernando Guerrero-Pérez
- Endocrinology & Nutrition Department. Hospital Universitario de Bellvitge. Cataluña L'Hospitalet de Llobregat, Spain
| | - Almudena Vicente
- Endocrinology & Nutrition Department. Hospital Universitario de Toledo. Toledo, Spain
| | - Juan Carlos Percovich
- Endocrinology & Nutrition Department. Hospital Universitario Gregorio Marañón. Madrid. Spain
| | - Rogelio García Centeno
- Endocrinology & Nutrition Department. Hospital Universitario Gregorio Marañón. Madrid. Spain
| | - Laura González
- Endocrinology & Nutrition Department. Hospital Universitario Gregorio Marañón. Madrid. Spain
| | | | - Ana Irigaray Echarri
- Endocrinology & Nutrition Department. Hospital Universitario Navarra. Pamplona, Spain
| | | | - Cristina Novo-Rodríguez
- Endocrinology & Nutrition Department. Hospital Universitario Virgen de las Nieves. Granada, Spain
| | - María Calatayud
- Endocrinology & Nutrition Department. Hospital Universitario Doce de Octubre. Madrid, Spain
| | - Rocío Villar
- Endocrinology & Nutrition Department. Hospital Universitario de Santiago de Compostela. Madrid, Spain
| | - Ignacio Bernabéu
- Endocrinology & Nutrition Department. Hospital Universitario de Santiago de Compostela. Madrid, Spain
| | | | | | - Carmen Tenorio-Jimenéz
- Endocrinology & Nutrition Department. Hospital Universitario Virgen de las Nieves. Granada, Spain
| | - Pablo Abellán Galiana
- Endocrinology & Nutrition Department. Hospital Universitario de Castellón. Valencia, Spain
| | - Eva Venegas Moreno
- Endocrinology & Nutrition Department. Hospital Universitario Virgen del Rocío. Sevilla, Spain
| | | | - Pedro Iglesias
- Endocrinology & Nutrition Department. Hospital Universitario Puerta de Hierro. Madrid, Spain
| | - Concepción Blanco
- Endocrinology & Nutrition Department. Hospital Universitario Príncipe de Asturias. Madrid, Spain
| | | | - Paz de Miguel
- Endocrinology & Nutrition Department. Hospital Clínico San Carlos. Madrid, Spain
| | - Elena López Mezquita
- Endocrinology & Nutrition Department. Hospital Universitario Clínico San Cecilio. Granada, Spain
| | - Felicia Hanzu
- Endocrinology & Nutrition Department. Hospital Clinic de Barcelona. Barcelona, Spain
| | - Iban Aldecoa
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Barcelona. Neurological Tissue Bank of the Biobank, FCRB-IDIBAPS-Hospital Clinic Barcelona, Barcelona
| | - Cristina Lamas
- Endocrinology & Nutrition Department. Hospital Universitario De Albacete, Albacete, Spain
| | - Silvia Aznar
- Endocrinology & Nutrition Department. Hospital Universitario De Albacete, Albacete, Spain
| | - Anna Aulinas
- Endocrinology & Nutrition Department. Hospital de la Santa Creu i Sant Pau, IR-SANT PAU, CIBERER U747 (ISCIII), Barcelona, Spain
| | - Anna Calabrese
- Internal Medicine Department. Hospital San Luigi Gonzaga, Turín, Italia and IR-SANTPAU, Barcelona, Spain
| | - Paola Gracia
- Endocrinology & Nutrition Department. Hospital Royo Villanova. Zaragoza. Spain
| | | | - Mariola Aviles
- Endocrinology & Nutrition Department. Hospital Universitario Clínico San Cecilio. Granada, Spain
| | - Diego Asensio-Wandosel
- Endocrinology & Nutrition Department. Hospital Universitario Germans Trias i Pujol. Cataluña, Spain
| | - Miguel Sampedro
- Endocrinology & Nutrition Department. Hospital Universitario La Princesa Madrid, Spain
| | - Ignacio Ruz-Caracuel
- Anatomopathological Department. Hospital Universitario Ramón y Cajal. Madrid, Spain & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS)
| | - Rosa Camara
- Endocrinology & Nutrition Department. Hospital La Fe. Valencia, Spain
| | - Miguel Paja
- Endocrinology & Nutrition Department. OSI Bilbao-Basurto. Hospital Universitario de Basurto. Bilbao, Spain & University of the Basque Country UPV/EHU
| | | | - Mónica Marazuela
- Endocrinology & Nutrition Department. Hospital Universitario La Princesa Madrid, Spain
| | - Manel Puig-Domingo
- Endocrinology & Nutrition Department. Hospital Universitario Germans Trias i Pujol. Cataluña, Spain
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Zhang D, Guo X, Feng M, Bao X, Deng K, Yao Y, Lian W, Xing B, Wang H. Preoperative and postoperative blood testosterone levels in patients with acromegaly: a prospective study. Front Endocrinol (Lausanne) 2023; 14:1259529. [PMID: 37886642 PMCID: PMC10598850 DOI: 10.3389/fendo.2023.1259529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/11/2023] [Indexed: 10/28/2023] Open
Abstract
Purpose To investigate the prevalence of low blood testosterone level (LTL) and its determinant factors among active male acromegaly patients, as well as the effect of surgery on LTL in male acromegaly patients. Methods A retrospective, single-center study focused on 252 male acromegaly patients aged 18 years-60 years diagnosed in the Peking Union Medical College Hospital from January 2015 to December 2018 was carried out. The measurements of preoperative and postoperative testosterone levels, serum growth hormone (GH), insulin-like growth factor 1 (IGF-1), and other clinical data were analyzed. Results Forty per cent of subjects included were diagnosed with LTL pre surgery. Patients were divided into normal testosterone level (NTL) and LTL groups based on their testosterone level. There were significant differences (p < 0.01) between groups in the presence of macroadenomas, invasion of the cavernous sinus, compression of the optic chiasm, and serum GH and prolactin levels pre surgery. Invasion of the cavernous sinus [odds ratio (OR) = 4.299; p = 0.000] and serum prolactin level (OR = 1.023, p = 0.001) were independent predictors of LTLs in male patients before surgical intervention. A total of 67.9% of LTL patients recovered during the follow-up, with a new-onset rate of 3.4%. Body mass index, invasion of the cavernous sinus, GH, IGF-1, and prolactin levels, the presence of a prolactin-secreting tumor, and recovery from acromegaly were significantly different (p < 0.05) in the NTL group and in the LTL group during the follow-up. The presence of a prolactin-secreting tumor (OR = 0.224; p = 0.001) and recovery from acromegaly (OR = 0.168; p = 0.006) were independent predictors of LTLs in male acromegaly patients during the follow-up. Conclusion The invasiveness of tumor and levels of blood prolactin are independent factors for LTLs before surgery, whereas GH and IGF-1 levels are not. Most male patients can recover from LTL after tumor restriction surgery: those who recover from acromegaly have a better chance of recovering from LTL.
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Affiliation(s)
- Duoxing Zhang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaopeng Guo
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology, China Pituitary Adenoma Specialist Council, Beijing, China
| | - Ming Feng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology, China Pituitary Adenoma Specialist Council, Beijing, China
| | - Xinjie Bao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology, China Pituitary Adenoma Specialist Council, Beijing, China
| | - Kan Deng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology, China Pituitary Adenoma Specialist Council, Beijing, China
| | - Yong Yao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology, China Pituitary Adenoma Specialist Council, Beijing, China
| | - Wei Lian
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology, China Pituitary Adenoma Specialist Council, Beijing, China
| | - Bing Xing
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology, China Pituitary Adenoma Specialist Council, Beijing, China
| | - Hanbi Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
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Araujo-Castro M, Marazuela M, Puig-Domingo M, Biagetti B. Prolactin and Growth Hormone Signaling and Interlink Focused on the Mammosomatotroph Paradigm: A Comprehensive Review of the Literature. Int J Mol Sci 2023; 24:14002. [PMID: 37762304 PMCID: PMC10531307 DOI: 10.3390/ijms241814002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Prolactin (PRL) and growth hormone (GH) are peptide hormones that bind to the class 1 cytokine receptor superfamily, a highly conserved cell surface class of receptors. Both hormones control their own secretion via a negative autocrine loop in their own mammosomatotroph, lactotroph or somatotroph. In this regard, GH and PRL are regulated by similar signaling pathways involving cell growth and hormone secretion. Thus, GH and PRL dysregulation and pituitary neuroendocrine tumor (PitNET) development may have common pathogenic pathways. Based on cell linage, lactotroph and somatotroph PitNETs come from pituitary-specific POU-class homeodomain transcription factor (Pit-1). Mammosomatotroph and plurihormonal PitNETs are a unique subtype of PitNETs that arise from a single-cell population of Pit-1 lineage. In contrast, mixed somatotroph-lactotroph PitNETs are composed of two distinct cell populations: somatotrophs and lactotrophs. Morphologic features that distinguish indolent PitNETs from locally aggressive ones are still unidentified, and no single prognostic parameter can predict tumor aggressiveness or treatment response. In this review, we aim to explore the latest research on lactotroph and somatotroph PitNETs, the molecular mechanisms involved in PRL and GH axis regulation and the signaling pathways involved in their aggressiveness, particularly focused on mammosomatotroph and mixed subtypes. Finally, we summarize epidemiological, clinical, and radiological features of these exceptional tumors. We aim to shed light, from basic to clinical settings, on new perspectives and scientific gaps in this field.
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Affiliation(s)
- Marta Araujo-Castro
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Colmenar Viejo Street km 9, 28034 Madrid, Spain
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Colmenar Viejo Street km 9, 28034 Madrid, Spain
| | - Mónica Marazuela
- Department of Endocrinology and Nutrition, Hospital Universitario La Princesa, 28006 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER GCV14/ER/12), Monforte de Lemos Avenue, 28029 Madrid, Spain
| | - Manel Puig-Domingo
- Department of Endocrinology and Nutrition, Department of Medicine, Germans Trias i Pujol Research Institute and Hospital, Universitat Autònoma de Barcelona, 08916 Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras CIBERER G747, Monforte de Lemos Avenue, 28029 Madrid, Spain
| | - Betina Biagetti
- Department of Endocrinology and Nutrition, Vall d’Hebron University Hospital, Reference Networks (ERN) and Vall d’Hebron Research Institute (VHIR), Vall d’Hebron Avenue, 119, 08035 Barcelona, Spain
- Diabetes and Metabolism Research Unit, Vall d’Hebron Research Institute and CIBERDEM (ISCIII), Universidad Autónoma de Barcelona, Avenida Can Domènech s/n, 08193 Bellaterra, Spain
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Jamil J, Wan Hassan WMN, Ghani AR, Yeap TB. Anaesthetic challenges in a patient with acromegaly and multinodular goitre undergoing endoscopic pituitary surgery. BMJ Case Rep 2023; 16:e250640. [PMID: 36796871 PMCID: PMC9936288 DOI: 10.1136/bcr-2022-250640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Acromegaly is a progressive systemic disorder which is common among middle-aged women. A functioning growth hormone-secreting pituitary adenoma is the most common cause. Anaesthesia for pituitary surgery in patients with acromegaly is challenging. Rarely, these patients may develop thyroid lesions that may compromise the airway. We present the case of a young man with newly diagnosed acromegaly caused by a pituitary macroadenoma complicated by a large multinodular goitre. The aim of this report is to discuss the perianaesthetic approach in patients with acromegaly with a high risk of airway compromise undergoing pituitary surgery.
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Affiliation(s)
- Jabraan Jamil
- Anaesthesia and Intensive Care Unit, Hospital Queen Elizabeth, Kota Kinabalu, Malaysia
| | | | - Ab Rahman Ghani
- Department of Neurosciences, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Tat Boon Yeap
- Department of Anaesthesia and Intensive Care, Universiti Sains Malaysia, Kota Bharu, Malaysia
- Department of Anaesthesia and Intensive Care, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
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Guo X, Zhang R, Zhang D, Wang Z, Gao L, Yao Y, Deng K, Bao X, Feng M, Xu Z, Yang Y, Lian W, Wang R, Ma W, Xing B. Hyperprolactinemia and Hypopituitarism in Acromegaly and Effect of Pituitary Surgery: Long-Term Follow-up on 529 Patients. Front Endocrinol (Lausanne) 2021; 12:807054. [PMID: 35154007 PMCID: PMC8825499 DOI: 10.3389/fendo.2021.807054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/30/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Studies on hyperprolactinemia and hypopituitarism in acromegaly are limited. We aimed to analyze the preoperative status, postoperative alterations, and correlated factors of hyperprolactinemia and hypopituitarism in acromegaly patients. METHODS This is a single-center cohort study with long-term follow-up. We prospectively enrolled 529 acromegaly patients. Hyperprolactinemia and hypopituitarism were evaluated by testing hypothalamus-pituitary-end organ (HPEO) axes hormones before and after surgery. RESULTS Hyperprolactinemia (39.1%) and hypopituitarism (34.8%) were common in acromegaly. The incidences of axis-specific hypopituitarism varied (hypogonadism, 29.7%; hypothyroidism, 5.9%; adrenal insufficiency, 5.1%), and multiple HPEO axes dysfunction was diagnosed in 5.3% of patients. Patients with preoperative hyperprolactinemia [hazard ratio (HR)=1.39 (1.08-1.79); p=0.012], hypogonadism [HR=1.32 (1.01-1.73); p=0.047], and hypothyroidism [HR=3.49 (1.90-6.44); p<0.001] had higher recurrence rates than those without. Age, sex, body mass index, tumor size, invasiveness, prolactin staining, ki-67 index, and GH/IGF-1 levels were significantly correlated with preoperative hypopituitarism and hyperprolactinemia. At median 34-month follow-up after surgery, hyperprolactinemia in 95% and axis-specific hypopituitarism in 54%-71% of patients recovered, whereas new-onset hypopituitarism (hypogonadism, 6.2%; hypothyroidism, 4.0%; adrenal insufficiency, 3.2%) was also diagnosed. A shorter tumor diameter was associated with the normalization of preoperative hyperprolactinemia after surgery. Cavernous sinus non-invasion, a shorter tumor diameter, cure at follow-up, and a lower GH nadir level were associated with the improvement of preoperative hypopituitarism after surgery. A larger tumor diameter was associated with the newly developed hypopituitarism after surgery. CONCLUSION Hyperprolactinemia and hypopituitarism are common among acromegaly patients and predict worse surgical outcomes. After surgery, improvement and worsening of HPEO axes function co-exist. Correlated factors are identified for clinical management.
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Affiliation(s)
- Xiaopeng Guo
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Center, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
| | - Ruopeng Zhang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Peking Union Medical College, Tsinghua University, Beijing, China
| | - Duoxing Zhang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Peking Union Medical College, Tsinghua University, Beijing, China
| | - Zihao Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Center, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
| | - Lu Gao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Center, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
| | - Yong Yao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Center, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
| | - Kan Deng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Center, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
| | - Xinjie Bao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Center, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
| | - Ming Feng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Center, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
| | - Zhiqin Xu
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Center, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
| | - Yi Yang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Center, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
| | - Wei Lian
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Center, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
| | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Center, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
| | - Wenbin Ma
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Center, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
| | - Bing Xing
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Center, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
- *Correspondence: Bing Xing,
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