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Akkus G, Odabaş F, Sözütok S, Sert M, Ak NE, Evran M, Tetiker T. Novel Classification of Acromegaly in Accordance with Immunohistochemical Subtypes: Is There Really a Clinical Relevance? Horm Metab Res 2022; 54:37-41. [PMID: 34844270 DOI: 10.1055/a-1685-0655] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
According to the recent studies, immunohistochemical subtypes of growth hormone (GH) secreting adenomas have been considered as a predictive factor in determining the clinical outcomes including biochemical, radiologic, and endocrine remission. In a 20 year-of time period, acromegaly patients who were treated and followed at the Endocrinology Department of our University Hospital were screened for the study. Of total 98 patients, 65 patients who had been operated by transsphenoidal surgery and having postoperative specimens were included. Postoperative specimens of the surgery of the patients were classified into 3 groups based on the histochemical characteristics (densely, sparsely, and mixed). Parasellar extensions of pituitary tumors were classified into the five grades according to Knosp classification. The patients were investigated and evaluated for postoperative clinical progress, remission rates, comorbidities regarding with the histopathological patterns. Of total 65 patients, 31 were classified as densely granulated (group 1), 32 were classified as sparsely granulated (group 2), and 2 patients were assessed as mixed granulated (group 3). There was no difference between groups for age and gender. Pre-treatment of adenoma size in all groups was correlated with each other and the frequency of macroadenoma (1 vs. 2, 77.4 vs. 84.3%) was higher in two groups. Although mean initial GH levels in group 1 was higher than the other groups (p=0.03), IGF1 levels (age and gender matched) were similar in each group. Adenomas in all groups demonstrated noninvasive radiological characteristics (Knosp grade 0-1-2). Ki-67 proliferation index of both groups (64.5 vs. 50%) was predominantly 1%. With a similar follow-up period, the endocrine remission rates (GH<1 μg/l) in groups were 64 vs. 69%, respectively. In conclusion, classification according to immunohistochemical subtypes of growth hormone secreting adenomas may not be a qualified parameter to evaluate patients with patterns of aggressiveness, clinical outcomes, or treatment response.
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Affiliation(s)
- Gamze Akkus
- Division of Endocrinology, Cukurova University, Adana, Turkey
| | - Fulya Odabaş
- Division of Endocrinology, Cukurova University, Adana, Turkey
| | - Sinan Sözütok
- Division of Radiology, Cukurova University, Adana, Turkey
| | - Murat Sert
- Division of Endocrinology, Cukurova University, Adana, Turkey
| | - Numan Emre Ak
- Internal Medicine Department, Cukurova University, Adana, Turkey
| | - Mehtap Evran
- Division of Endocrinology, Cukurova University, Adana, Turkey
| | - Tamer Tetiker
- Division of Endocrinology, Cukurova University, Adana, Turkey
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Wildemberg LE, Henriques D, Elias PCL, Lima CHDA, Musolino NRDC, Camacho AHS, Faria O, Nazato D, Abucham J, Vilar L, Mota JI, Huayllas MKP, Chimelli L, de Castro M, Kasuki L, Gadelha MR. gsp Mutation Is Not a Molecular Biomarker of Long-Term Response to First-Generation Somatostatin Receptor Ligands in Acromegaly. Cancers (Basel) 2021; 13:cancers13194857. [PMID: 34638340 PMCID: PMC8508484 DOI: 10.3390/cancers13194857] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/05/2021] [Accepted: 09/23/2021] [Indexed: 12/01/2022] Open
Abstract
Simple Summary Acromegaly treatment consists of surgical, medical, and radiation therapy. First-generation somatostatin receptor ligands are the mainstay of medical therapy, with approximately 40% disease control rate. Several parameters have been evaluated as predictors of response to these drugs, including mutations in the stimulatory G-protein α subunit (gsp mutation), which is still controversial. In this study, we aimed to evaluate in a large series of patients whether gsp mutation predicts long-term response to medical treatment and to characterize the gsp mutated population. The ability to predict response to medical therapy would help to choose a therapy that presents higher odds of controlling the disease, which ultimately would reduce treatment costs and disease morbi-mortality. Abstract Background: It is still controversial if activating mutations in the stimulatory G-protein α subunit (gsp mutation) are a biomarker of response to first generation somatostatin receptor ligands (fg-SRL) treatment in acromegaly. Thus, we aimed to evaluate whether gsp mutation predicts long-term response to fg-SRL treatment and to characterize the phenotype of patients harboring gsp mutations. Methods: GNAS1 sequencing was performed by Sanger. SST2 and SST5 were analyzed by immunohistochemistry (IHC) and real-time RT-PCR. The cytokeratin granulation pattern was evaluated by IHC. Biochemical control was defined as GH < 1.0 ng/mL and normal age-adjusted IGF-I levels. Results: gsp mutation was found in 54 out of 136 patients evaluated. Biochemical control with fg-SRL treatment was similar in gsp+ and gsp- patients (37% vs. 25%, p = 0.219). Tumors harboring gsp mutation were smaller (p = 0.035) and had a lower chance of invading cavernous sinuses (p = 0.001). SST5 protein (p = 0.047) and mRNA (p = 0.013) expression levels were higher in wild-type tumors. Conclusions: In this largest series available in the literature, we concluded that gsp is not a molecular biomarker of response to fg-SRL treatment in acromegaly. However, the importance of its negative association with cavernous sinus invasion and SST5 expression needs to be further investigated.
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Affiliation(s)
- Luiz Eduardo Wildemberg
- Endocrine Unit and Neuroendocrinology Research Center, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-617, Brazil; (L.E.W.); (D.H.); (O.F.); (L.K.)
- Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro 20231-092, Brazil
| | - Daniel Henriques
- Endocrine Unit and Neuroendocrinology Research Center, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-617, Brazil; (L.E.W.); (D.H.); (O.F.); (L.K.)
| | - Paula C. L. Elias
- Division of Endocrinology, Department of Internal Medicine, Ribeirao Preto Medical School, Universidade de São Paulo, Ribeirão Preto 14049-900, Brazil; (P.C.L.E.); (M.d.C.)
| | - Carlos Henrique de A. Lima
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro 20231-092, Brazil; (C.H.d.A.L.); (A.H.S.C.); (L.C.)
| | - Nina R. de Castro Musolino
- Neuroendocrine Unit, Division of Functional Neurosurgery, Hospital das Clínicas da Universidade de São Paulo, São Paulo 05403-000, Brazil;
| | - Aline Helen Silva Camacho
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro 20231-092, Brazil; (C.H.d.A.L.); (A.H.S.C.); (L.C.)
| | - Olivia Faria
- Endocrine Unit and Neuroendocrinology Research Center, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-617, Brazil; (L.E.W.); (D.H.); (O.F.); (L.K.)
| | - Debora Nazato
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo 04023-062, Brazil; (D.N.); (J.A.)
| | - Julio Abucham
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo 04023-062, Brazil; (D.N.); (J.A.)
| | - Lucio Vilar
- Division of Endocrinology, Hospital das Clínicas da Universidade Federal de Pernambuco, Recife 50670-901, Brazil;
| | - Jose Italo Mota
- Endocrinology and Metabolism Unit, Hospital Geral de Fortaleza, Secretaria Estadual de Saúde, Fortaleza 60150-160, Brazil;
| | | | - Leila Chimelli
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro 20231-092, Brazil; (C.H.d.A.L.); (A.H.S.C.); (L.C.)
| | - Margaret de Castro
- Division of Endocrinology, Department of Internal Medicine, Ribeirao Preto Medical School, Universidade de São Paulo, Ribeirão Preto 14049-900, Brazil; (P.C.L.E.); (M.d.C.)
| | - Leandro Kasuki
- Endocrine Unit and Neuroendocrinology Research Center, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-617, Brazil; (L.E.W.); (D.H.); (O.F.); (L.K.)
- Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro 20231-092, Brazil
| | - Mônica R. Gadelha
- Endocrine Unit and Neuroendocrinology Research Center, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-617, Brazil; (L.E.W.); (D.H.); (O.F.); (L.K.)
- Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro 20231-092, Brazil
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro 20231-092, Brazil; (C.H.d.A.L.); (A.H.S.C.); (L.C.)
- Correspondence: ; Tel./Fax: +55-21-3938-2111
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Abstract
Background To examine the clinical and hormonal profiles, comorbidities, treatment patterns, surgical pathology and clinical outcomes of patients diagnosed with acromegaly at the Cleveland Clinic over a 15-year period. Methods A retrospective chart review of patients with acromegaly who underwent surgical resection between 2003 and 2018. Results A total of 136 patients (62 men; mean age 48.1 years) with biochemical evidence of acromegaly were analyzed. Median insulin-like growth factor 1 (IGF-1) level at diagnosis was 769.0 ng/mL and most patients had a macroadenoma (82.2%). Immunoreactivity to growth hormone (GH) was noted in 124 adenomas, with co-staining in 89 adenomas. Complete visible tumor resection during initial surgery was achieved in 87 patients (64.0%). In this cohort, complete response to surgery alone was observed in 61 patients (70.1%), while 31 out of 65 patients (47.7%) who received additional post-surgical medications and/or radiation therapy achieved complete response. At most recent follow-up, 92 patients achieved eventual complete response by documented normalization of IGF-1 levels. Higher IGF-1 level at diagnosis (P = 0.024) and cavernous sinus invasion (P = 0.028) were predictors for failure to respond to surgery. Conclusion In this study, the majority of tumors were macroadenoma, plurihormonal, and treated effectively with surgery alone or surgery with adjuvant medical or radiation therapy. More studies are needed to identify additional molecular biomarkers, tumor characteristics and imaging findings to individualize treatment and better predict treatment outcomes.
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