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Growth hormone tumor histological subtypes predict response to surgical and medical therapy

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Abstract

Growth hormone (GH) pituitary tumors are associated with significant morbidity and mortality. Current treatments, including surgery and medical therapy with somatostatin analogs (SSA), dopamine agonists and/or a GH receptor antagonist, result in disease remission in approximately half of patients. Predictors of GH tumor response to different therapies have been incompletely defined based on histologic subtype, particularly densely (DG) versus sparsely (SG) granulated adenomas. The aim of this study was to examine our own institutional experience with GH adenomas and correlate how subtype related to clinical parameters as well as response to surgery and medical therapies. A retrospective chart review of 101 acromegalic patients operated by a single neurosurgeon was performed. Clinical data were correlated with histologic subtype and disease control, as defined by IGF-1 levels, and random growth hormone levels in response to surgery and/or medical therapies. SG tumors, compared to DG, occurred in younger patients (p = 0.0010), were 3-fold larger (p = 0.0030) but showed no differences in tumor-invasion characteristics (p = 0.12). DG tumors had a higher rate of remission in response to surgery compared to SG, 65.7 vs. 14.3 % (p < 0.0001), as well as to medical therapy with SSAs (68.8 % for DG vs. 28.6 % for SG tumors; p = 0.028). SG tumors not controlled with SSAs consistently responded to a switch to, or addition of, a GH receptor antagonist. Histological GH tumor subtyping implicates a different clinical phenotype and biologic behavior, and provides prognostic significance for surgical success and response to medical therapies.

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Acknowledgments

The authors would like to thanks Molly Levitt for help in constructing initial patient database and participation in data collection. This work was supported by Investigator Initiated Grant from Pfizer, Inc and VA Merit Review to MEW, and NIH K12CA086913-12 to KKV.

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The authors have nothing to disclose.

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Authors and Affiliations

  1. Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, 12801 East 17th Ave, RC1 South Room 7402A, Aurora, CO, 80045, USA

    Katja Kiseljak-Vassiliades, Janice M. Kerr & Margaret E. Wierman

  2. Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus Aurora, Aurora, CO, 80045, USA

    Nichole E. Carlson

  3. Department of Radiology, University of Colorado Anschutz Medical Campus Aurora, Aurora, CO, 80045, USA

    Manuel T. Borges

  4. Department of Pathology, University of Colorado Anschutz Medical Campus Aurora, Aurora, CO, 80045, USA

    B. K. Kleinschmidt-DeMasters

  5. Department of Neurosurgery, University of Colorado Anschutz Medical Campus Aurora, Aurora, CO, 80045, USA

    B. K. Kleinschmidt-DeMasters & Kevin O. Lillehei

  6. Research Service Veterans Affairs Medical Center, Denver, CO, 80220, USA

    Katja Kiseljak-Vassiliades & Margaret E. Wierman

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  1. Katja Kiseljak-Vassiliades
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Correspondence to Katja Kiseljak-Vassiliades.

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Kiseljak-Vassiliades, K., Carlson, N.E., Borges, M.T. et al. Growth hormone tumor histological subtypes predict response to surgical and medical therapy. Endocrine 49, 231–241 (2015). https://doi.org/10.1007/s12020-014-0383-y

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