Predictive factors for post-therapeutic biochemical discordance in acromegaly: a monocentric analysis of 156 cases.

IF 3.3 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Pituitary Pub Date : 2025-06-22 DOI:10.1007/s11102-025-01547-8

Dimitrios Emmanouilidis, Witold Polanski, Tareq Juratli, Stephan B Sobottka, Elena Tsourdi, Matthias Gruber, Thomas Pinzer, Ilker Y Eyüpoglu

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引用次数: 0

Abstract

Purpose: Biochemical remission is the primary treatment goal in acromegaly. However, some patients experience biochemical discordance between growth hormone (GH) and insulin-like growth factor-I (IGF-I) levels following multimodal therapy, complicating disease assessment and management. This study aims to identify predictive factors associated with post-therapeutic biochemical discrepancy.

Methods: We conducted a retrospective monocentric analysis of 156 patients with GH-producing pituitary adenomas (PAs) who underwent transsphenoidal surgery between 1984 and 2017. Biochemical outcomes were classified into four groups: group 1 (biochemical remission), group 2 (isolated GH normalization), group 3 (isolated IGF-I normalization), and group 4 (persistent acromegaly). Predictive factors for biochemical discrepancy were assessed, including demographic data, tumor characteristics, medication, irradiation, follow up duration, and disease recurrence.

Results: The median age of the cohort was 48.2 years, with a female predominance (61.5%). Most PAs were macroadenomas (79.6%) and invasive (53.9%). Biochemical remission was achieved in 69.9%, while 19.2% exhibited biochemical discrepancy. Univariate analysis identified overall medication (pre- and/or postoperative), irradiation, and invasive PAs as significant factors associated with biochemical discordance. Logistic regression confirmed medication as the most influential predictor, with irradiation as a potential contributing factor. Disease recurrence was the only distinguishing factor between persistent acromegaly and biochemical discrepancy.

Conclusion: Overall medication use is the strongest predictor of biochemical discrepancy, with irradiation potentially contributing. No clear distinguishing factors between biochemical discordance and persistent acromegaly were identified, except from disease recurrence. Managing patients with biochemical discrepancy similarly to those with persistent acromegaly may be advisable. Further research is needed to refine treatment strategies.

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肢端肥大症治疗后生化不一致的预测因素：156例单中心分析

目的：生化缓解是肢端肥大症的主要治疗目标。然而，一些患者在多模式治疗后出现生长激素（GH）和胰岛素样生长因子- i （IGF-I）水平的生化失调，使疾病评估和管理复杂化。本研究旨在确定与治疗后生化差异相关的预测因素。方法：我们对1984年至2017年间接受经蝶窦手术的156例gh -垂体腺瘤（PAs）患者进行了回顾性单中心分析。生化结果分为四组：1组（生化缓解）、2组（孤立GH正常化）、3组（孤立IGF-I正常化）和4组（持续性肢端肥大症）。评估生化差异的预测因素，包括人口统计学数据、肿瘤特征、用药、放疗、随访时间和疾病复发。结果：队列的中位年龄为48.2岁，女性占多数（61.5%）。多数PAs为大腺瘤（79.6%）和侵袭性（53.9%）。生化缓解者占69.9%，生化差异者占19.2%。单因素分析确定总体用药（术前和/或术后）、放疗和侵入性PAs是与生化不一致相关的重要因素。Logistic回归证实药物是最具影响的预测因子，照射是一个潜在的影响因素。疾病复发是区分持续性肢端肥大症和生化差异的唯一因素。结论：总体用药是生化差异的最强预测因子，照射可能有影响。除了疾病复发外，没有明确的区分生化不一致和持续性肢端肥大症的因素。与持续性肢端肥大症相似的生化差异患者的处理可能是可取的。需要进一步的研究来完善治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pituitary 医学-内分泌学与代谢

CiteScore

7.10

自引率

7.90%

发文量

审稿时长

6 months

期刊介绍： Pituitary is an international publication devoted to basic and clinical aspects of the pituitary gland. It is designed to publish original, high quality research in both basic and pituitary function as well as clinical pituitary disease. The journal considers: Biology of Pituitary Tumors Mechanisms of Pituitary Hormone Secretion Regulation of Pituitary Function Prospective Clinical Studies of Pituitary Disease Critical Basic and Clinical Reviews Pituitary is directed at basic investigators, physiologists, clinical adult and pediatric endocrinologists, neurosurgeons and reproductive endocrinologists interested in the broad field of the pituitary and its disorders. The Editorial Board has been drawn from international experts in basic and clinical endocrinology. The journal offers a rapid turnaround time for review of manuscripts, and the high standard of the journal is maintained by a selective peer-review process which aims to publish only the highest quality manuscripts. Pituitary will foster the publication of creative scholarship as it pertains to the pituitary and will provide a forum for basic scientists and clinicians to publish their high quality pituitary-related work.