Caracterización de tumores secretores de hormona de crecimiento de acuerdo al patrón granular y su rol en el pronóstico

Felipe Valenzuela,Claudia Tissera,Pablo Villanueva,René E Díaz,Nelson Wohllk,Carmen A Carrasco,David Rojas Z,Roger Gejman,Isidro Huete,Romina Zunino

doi:10.4067/s0034-98872019000700852

Abstract

Classification of growth hormone (GH) - secreting tumors by the granular pattern might predict their clinical behavior in acromegalic patients. There are several other prognostic factors. To compare the features at presentation and cure rates of patients with GH secreting tumors according to the granular pattern, and to define independent prognostic factors for surgical treatment in these patients. A retrospective, observational study of 85 active acromegalic patients surgically treated in two medical centers. Seventy-four patients (87%) were classified as having densely granulated (DG) and 11 (13%) as sparsely granulated (SG) tumors. The latter were less active biochemically, had a higher rate of macroadenoma and cavernous sinus invasion and had a lower rate of biochemical cure than the DG group. Several characteristics were associated with disease persistence but only age (Odds ratio (OR) = 0.93) and cavernous sinus invasion (OR = 21.7) were independently associated in the logistic regression model. The sparsely granulated pattern is associated with a more aggressive behavior, but the main determinants of prognosis are age and cavernous sinus invasion.

Highlights

Caracterización de tumores secretores de hormona de crecimiento de acuerdo al patrón granular y su rol en el pronóstico
Prognostic value of granular pattern of growth hormone secreting tumors Background: Classification of growth hormone (GH) - secreting tumors by the granular pattern might predict their clinical behavior in acromegalic patients
Aim: To compare the features at presentation and cure rates of patients with GH secreting tumors according to the granular pattern, and to define independent prognostic factors for surgical treatment in these patients

Summary

Pacientes y Métodos

Pacientes Se realizó un estudio retrospectivo de los pacientes con adenoma somatotropo operados por dos neurocirujanos entre 1999 y 2014, en dos centros hospitalarios chilenos. Se definió IGF1 indexada como la relación entre el valor de IGF1 plasmática preoperatoria de cada sujeto dividida por el valor superior del rango de normalidad para el mismo sujeto. La medición de prolactina fue hecha por inmunoensayo quimioluminométrico (ADVIA Centaur o Immulite Siemens) y se consideró como hiperprolactinemia valores por sobre el nivel superior del rango de normalidad ajustados por edad y género. La curación bioquímica postquirúrgica se definió por: a) niveles plasmáticos de IGF1 por debajo del valor máximo normal, o b) un nadir de GH ≤ 0,4 ng/mL durante un test de sobrecarga con glucosa a los tres meses de la cirugía[13]. En 3 de los 85 pacientes incluidos en el análisis no se obtuvieron datos del estado bioquímico de actividad postoperatoria (uno en grupo EG y dos en DG).

Histología Escasamente granular Densamente granular

Findings

DG en test agudo de octreotide