Novel Classification of Acromegaly in Accordance with Immunohistochemical Subtypes: Is There Really a Clinical Relevance?

A single-center prospective study evaluating the relationship of tumor consistency on remission in acromegaly patients

The nature of somatotroph adenomas has not been clearly revealed in studies. We consider that there are macroscopic differences in intraoperative tumor consistency in acromegaly patients. We aimed to determine whether there is a relationship between intraoperative tumor consistency and histopathological subtypes by planning a prospective study to determine whether these differences are significant. Between August 1997 and December 2021, 1118 patients with GH-secreting tumors underwent endoscopic endonasal surgery at our Pituitary Research Center. Between January 2022 and May 2023, pure GH-secreting adenomas operated via the endoscopic endonasal approach were sequentially categorized into three types(Type-1:Soft, Type-2:Mucinous/Adhesive, Type-3:Mix/Intermediate) according to the intraoperative tumor consistency. The final patient cohort consisted 218 cases. The ratio of densely granulated adenomas(DG-A) to sparsely granulated adenomas(SG-A) was as follows: Type-1, 89/11; Type-2, 5/95; Type-3, 13/5. Logistic regression revealed that Type-1 tumors were associated with a high remission rate(p = 0.011), and Type-2 were associated with SG-A(p < 0.001). Furthermore, no or weak staining for E-cadherin was associated with Type-2 tumors(p < 0.001). Surgeon could predict the prognosis and histopathological subtype of the pure somatotroph adenoma by observing the intraoperative tumor consistency. This could facilitate better intraoperative planning of patient-specific surgical strategies to increase the remission rates.

Diagnostic delay, older age, and hormonal levels at diagnosis affect disease burden and mortality in acromegaly

PURPOSE

Acromegaly, a rare disease with peak incidence in early adulthood, is marked by significant diagnostic delay and increased mortality due to complications. While older patients often show milder disease activity, they experience longer diagnostic delay. Higher hormonal levels, advanced age, and prolonged delay are associated with more systemic complications. The interplay between hormonal levels, age at diagnosis, and diagnostic delay on disease activity and complications remains unclear. This study aimed to assess the hormonal and cardiometabolic features, as well as mortality, of acromegaly based on diagnostic delay and age at diagnosis.

METHODS

A retrospective study of 203 acromegalic patients, stratified by age at diagnosis (< 65 years, n = 175; ≥ 65 years, n = 28) and diagnostic delay (≤ 5 years, n = 103; > 5 years, n = 100). Data on clinical and hormonal profiles, cardiometabolic complications, and mortality were analyzed.

RESULTS

In multivariate analysis, age at diagnosis and diagnostic delay did not predict higher IGF-I SDS, which was associated only with male gender (OR 3.70, p = 0.001) and cardiometabolic burden (OR 3.36, p = 0.02). Younger age (OR 0.94, p = 0.000) and longer diagnostic delay (OR 1.15, p = 0.002) correlated with higher GH levels. Older age (OR 1.12, p = 0.000) and higher IGF-I SDS (OR 3.06, p = 0.02) were linked to greater cardiometabolic burden. Mortality was higher in older patients (OR 1.03, p = 0.03) and those with longer diagnostic delay (OR 1.10, p = 0.02).

CONCLUSIONS

1) older age at diagnosis strongly impacts cardiometabolic complications, while diagnostic delay has a lesser effect; 2) male gender, older age, diagnostic delay, and cardiometabolic burden predict hormonal disease burden; 3) older age and IGF-I SDS predict cardiometabolic complications; 4) mortality is predicted by older age and prolonged diagnostic delay.

Pathologic Characteristics of Somatotroph Pituitary Tumors-An Observational Single-Center Study

The pathologic evaluation of a tumor tissue is an essential part of an acromegaly patient's assessment. This study aimed to analyze the pathologic characteristics of pituitary tumors in patients with acromegaly. The demographic data, in addition to the hormonal, imaging, and pathologic results of 120 patients with acromegaly after pituitary surgery, were extracted from the Polish Acromegaly Registry. We compared sparsely and densely granulated tumors, GH(+), mixed GH(+)/PRL(+) and plurihormonal tumors, α-subunit-positive and α-subunit-negative tumors, and tumors of various Ki-67 indices in terms of the abovementioned features. Sparsely granulated tumors were more frequent in women than in men (p = 0.001) and in younger patients (p = 0.011), and they were larger (p < 0.001) compared to densely granulated tumors. Tumors with positive α-subunit were smaller (p = 0.013), showed extrasellar extension less often (p = 0.039), and were more often densely granulated (p < 0.001) compared to α-subunit-negative tumors. Patients with a higher Ki-67 index were younger (p < 0.001) and more often diagnosed with genetic syndromes (p = 0.02); they had higher GH concentrations (p = 0.007), larger tumors (p = 0.006), and cavernous sinus invasions more frequently (p = 0.022). Conclusions: The pathologic characteristics of somatotroph pituitary tumors are associated with patient's age, sex, hormonal results, tumor size, and the degree of extrasellar expansion.

Prognostic Models in Growth-Hormone- and Prolactin-Secreting Pituitary Neuroendocrine Tumors: A Systematic Review

Growth-hormone (GH)- and prolactin (PRL)-secreting PitNETs (pituitary neuroendocrine tumors) are divided into multiple histological subtypes, which determine their clinical and biological variable behavior. Proliferation markers alone have a questionable degree of prediction, so we try to identify validated prognostic models as accurately as possible. (1) Background: The data available so far show that the use of staging and clinical-pathological classification of PitNETs, along with imaging, are useful in predicting the evolution of these tumors. So far, there is no consensus for certain markers that could predict tumor evolution. The application of the WHO (World Health Organisation) classification in practice needs to be further evaluated and validated. (2) Methods: We performed the CRD42023401959 protocol in Prospero with a systematic literature search in PubMed and Web of Science databases and included original full-text articles (randomized control trials and clinical trials) from the last 10 years, published in English, and the search used the following keywords: (i) pituitary adenoma AND (prognosis OR outcome OR prediction), (ii) growth hormone pituitary adenoma AND (prognosis OR outcome OR prediction), (iii) prolactin pituitary adenoma AND (prognosis OR outcome OR prediction); (iv) mammosomatotroph adenoma AND (prognosis OR outcome OR prediction). (3) Results: Two researchers extracted the articles of interest and if any disagreements occurred in the selection process, these were settled by a third reviewer. The articles were then assessed using the ROBIS bias assessment and 75 articles were included. (4) Conclusions: the clinical-pathological classification along with factors such as GH, IGF-1, prolactin levels both preoperatively and postoperatively offer valuable information.