RESUMO
OBJECTIVE: The aim of this study is to compare the response to first-line medical treatment in treatment-naive acromegaly patients with pure growth hormone (GH)-secreting pituitary adenoma (GH-PA) and those with GH and prolactin cosecreting PA (GH&PRL-PA). DESIGN: This is a retrospective multicentric study of acromegaly patients followed from 2003 to 2023 in 33 tertiary Spanish hospitals with at least 6 months of first-line medical treatment. METHODS: Baseline characteristics, first-line medical treatment strategies, and outcomes were analyzed. We employed a multiple logistic regression full model to estimate the impact of some baseline characteristics on disease control after each treatment modality. RESULTS: Of the 144 patients included, 72.9% had a GH-PA, and 27.1% had a GH&PRL-PA. Patients with GH&PRL-PA were younger (43.9 ± 15.0 vs 51.9 ± 12.7 years, P < .01) and harboring more frequently macroadenomas (89.7% vs 72.1%, P = .03). First-generation somatostatin receptor ligand (fgSRL) as monotherapy was given to 106 (73.6%) and a combination treatment with fgSRL and cabergoline in the remaining 38 (26.4%). Patients with GH&PRL-PA received more frequently a combination therapy (56.4% vs 15.2%, P < .01). After 6 months of treatment, in the group of patients under fgSRL as monotherapy, those patients with GH&PRL-PA had worse control compared to GH-PAs (29.4% vs 55.1%, P = .04). However, these differences in the rate of disease control between both groups disappeared when both received combination treatment with fgSRL and cabergoline. CONCLUSION: In GH&PRL-PA, the biochemical control achieved with fgSRL as monotherapy is substantially worse than in patients harboring GH-PA, supporting the inclusion of cabergoline as first-line medical treatment in combination with fgSRLs in these subgroups of patients.
Assuntos
Acromegalia , Cabergolina , Prolactina , Humanos , Acromegalia/tratamento farmacológico , Acromegalia/sangue , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto , Cabergolina/uso terapêutico , Resultado do Tratamento , Prolactina/sangue , Adenoma Hipofisário Secretor de Hormônio do Crescimento/tratamento farmacológico , Adenoma Hipofisário Secretor de Hormônio do Crescimento/sangue , Adenoma Hipofisário Secretor de Hormônio do Crescimento/metabolismo , Hormônio do Crescimento Humano , Adenoma/tratamento farmacológico , Adenoma/sangue , Adenoma/metabolismo , Adenoma/complicações , Idoso , Quimioterapia Combinada , Somatostatina/análogos & derivados , Somatostatina/uso terapêutico , Neoplasias Hipofisárias/tratamento farmacológico , Neoplasias Hipofisárias/sangue , Neoplasias Hipofisárias/metabolismo , Neoplasias Hipofisárias/complicações , Espanha/epidemiologiaRESUMO
Obesity has recently become one of the most important public health problems. It is associated with a high rate of mortality, mainly because of cardiovascular disease, and can cause hormonal abnormalities such as hypogonadotropic hypogonadism. Weight loss is very beneficial for obese patients, because it results in improvement or even normalization of these conditions. In this report, we describe a morbidly obese patient with hypogonadotropic hypogonadism, which was probably caused by hyperprolactinemia and exacerbated by obesity-induced hormonal imbalances. After medical treatment for hyperprolactinemia and bariatric surgery, the patient's hormonal status became normal. Although morbid obesity can cause hypogonadotropic hypogonadism in men, the differential diagnosis should include other potential causes of hypogonadism if free testosterone levels are below normal.