OBJECTIVE: 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 co-secreting PA (GH&PRL-PA). DESIGN: Retrospective multicentric study of acromegaly patients followed from 2003 to 2023 in 33 tertiary Spanish hospitals with at least six months of first-line medical treatment. METHODS: Baseline characteristics, first-line medical treatment strategies, and outcomes were analysed. 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 < 0.01) and harboring more frequently macroadenomas (89.7% vs. 72.1%, p = 0.03). 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 < 0.01). 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 = 0.04). 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.
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.
BACKGROUND AND OBJECTIVE: Our study was designed to assess the impact on nitrogen and glucose metabolism when it is administered either as discontinuous or as continuous infusion. PATIENTS AND METHOD: We assessed the nutritional efficacy (nitrogen balance) and hyperinsulinism risk (urine C peptide excretion) of enteral nutrition in 23 patients hospitalized because of acute stroke. RESULTS: The feeding tolerance of our enteral nutrition protocol (nasoenteric catheter) was full in every patient. The nitrogen balance was positive in both patterns, but the balance in the continuous feeding pattern was better than in the bolus feeding one. On the contrary, the urine C peptide excretion was increased when enteral nutrition was administered intermittently as compared with continuous feeding. Calciuria was greater in the continuous fed pattern than in the bolus feeding. CONCLUSIONS: Continuous feeding is associated with better nitrogen balance and less urine C peptide excretion than intermittent feeding. These results suggest that continuous feeding would be an interesting choice to improve glucose control in diabetic patients with enteral nutrition.
C-Peptide/urine , Cardiovascular Diseases/metabolism , Cardiovascular Diseases/therapy , Enteral Nutrition/methods , Nitrogen/metabolism , Aged , Female , Humans , Male
FUNDAMENTO Y OBJETIVO: Valoramos el impactodel paso de nutrición enteral continua a nutriciónen bolo de nuestro protocolo sobre el metabolismonitrogenado y glucídico.PACIENTES Y MÉTODO: Valoramos la eficacia nutricionalmediante el cálculo del balance nitrogenadoy el posible riesgo de hiperinsulinismocon la determinación de péptido C urinario en23 pacientes hospitalizados por accidente cerebrovascularagudo.RESULTADOS: La tolerancia digestiva a la instauraciónde nutrición enteral por sonda nasogástricacon el protocolo descrito fue total en todoslos casos. El balance nitrogenado fuepositivo con las dos pautas, pero el balancefue mejor con la administración continua. Porel contrario, los valores urinarios de péptido Cse incrementan cuando se pasa de la administracióncontinua a bolo.CONCLUSIONES: La administración continua denutrición enteral se asoció con mejor balancenitrogenado y una menor excreción de péptidoC urinario. Estos resultados sugieren que estaforma de administración podría ser de interéspara mejorar el control glucémico del pacientediabético con nutrición enteral
BACKGROUND AND OBJECTIVE: Our study was designedto assess the impact on nitrogen and glucosemetabolism when it is administered either asdiscontinuous or as continuous infusion.PATIENTS AND METHOD: We assessed the nutritionalefficacy (nitrogen balance) and hyperinsulinismrisk (urine C peptide excretion) of enteralnutrition in 23 patients hospitalizedbecause of acute stroke.RESULTS: The feeding tolerance of our enteralnutrition protocol (nasoenteric catheter) wasfull in every patient. The nitrogen balance waspositive in both patterns, but the balance inthe continuous feeding pattern was better thanin the bolus feeding one. On the contrary, theurine C peptide excretion was increased whenenteral nutrition was administered intermittentlyas compared with continuous feeding.Calciuria was greater in the continuous fedpattern than in the bolus feeding.CONCLUSIONS: Continuous feeding is associatedwith better nitrogen balance and less urine Cpeptide excretion than intermittent feeding. Theseresults suggest that continuous feeding wouldbe an interesting choice to improve glucose controlin diabetic patients with enteral nutrition
Male , Female , Aged , Humans , C-Peptide/urine , Cardiovascular Diseases/metabolism , Cardiovascular Diseases/therapy , Enteral Nutrition/methods , Nitrogen/metabolism
