The Basic And Clinical Research Of Acromegaly Patients With GH-secreting Pituitary Adenomas

Part1Clinical analysis of634patients with GH-secreting pituitaryadenomasBackground and ObjectiveAcromegaly is a rare disease characterized by excess secretion of growth hormoneand increased serum concentrations of insulin-like growth factor1. About ninety-fivepercent of cases, the cause of GH hypersecretion is a pituitary adenoma. Over the recentyears, there have been significant advances in surgery, medical management, andradiotherapy for patients with acromegaly，while the morbidity and premature mortality ofthe disease is still increased. The most cause of death is cardiovascular, andcerebrovascular, respiratory, metabolic complications are also causes of the increasedmorbidity. The aim of this study was to analysis the clinical data of acromegalic underwentsurgery patients with GH-secreting pituitary adenomas.Patients and methods:A retrospective and descriptive study was performed with634patients whounderwent surgery and confirmed by pathology of GH-secreting adenomas. Clinical datasuch as age of primary diagnosis, height，weight，blood pressure，clinical manifestationsand complications, tumor size, pre-and postoperative hormonal level were collected.ResultsThe mean age of the time of primary diagnose was42±12year.The most commonpresenting clinical manifestations or complications were acromegaly（71.45%）、coarsefacial feature（54.57%），hypertension (37.79%). The mean body mass index(BMI) was25.80±3.59kg/m2. of which <24kg/m2and≥28kg/m2were respectively33.17%and23.56%,the other43.27%were between24and28kg/m2.The mean blood pressure was127±16.36/80.58±11.57mmHg,23.45%of them systolic blood pressure(SBP)≥140mmHg and23.65%of them diastolic blood pressure(DBP)≥90mmHg.The average fast bloodglucose(FPG) was6.30±2.09mmol/L,63.21%of them were＜6.0mmol/L,6.0-7.0mmol/L and＞7.0mmol/L were17.56%and19.23%respectively. About90%of theadenomas were macro adenoma. Surgery can reduce the excessive secretion of GH、IGF–1and PRL (85.52±99.52ug/L vs15.03±36.36ug/L,740.74±282.13ng/ml vs526.89±263.93ng/ml，36.69±58.1ng/ml vs9.56±17.36ng/ml respectively,p<0.05). Therewere significant correlation between tumor size and GH(r=0.27,p=0.002)、IGF-1(r=0.26,p=0.027)、PRL(r=0.23,p=0.012) level.ConclusionPituitary GH adenoma was more for30to60years old and having no significant genderdifferences.At the time of diagnosis, men were younger than women. The prevalence ofhypertension, glucose metabolic disorder and overweight were higher than the generalpopulation. Compared with microadenoma, the patients with macroadenoma had higherGH、IGF-1and PRL levels. Surgery can quickly reduce the excessive secretion of GH andIGF-1. Part2The relationship between somatostatin receptorexpression in pituitary GH-secretion adenomas and itssensitivityBackground and ObjectiveSo far, a number of studies have found that patients with acromegaly receivedsomatostatin analogues (SSTA) treatment can make their biochemical control and thesymptoms alleviated. SSTA used before surgery is expected to be able to shrink the tumorsize, inhibit the excess GH and IGF-1secretion, reversal of the signs and symptoms,improve vision disorders, soften tumor tissue and reduce mortality. Somatostatin receptors(SSTR) have five subtypes: SSTR1-SSTR5, which has high affinity with somatostatin, butits affinity with the somatostatin analogue octreotide is relatively different. Octreotide hashigh affinity SSTR2and SSTR5. This study selected the antibodies SSTR2and SSTR5, which have high affinity withoctreotide and did immunohistochemistry on the adenomas pathological diagnosed ofgrowth hormone secretion to investigate that whether the use of SSTs would influence theexpression of somatostatin receptors and the correlation between the expression and drugsensitivity.Patients and methods:We selected88patients with pituitary tumor growth hormone between2008-2013inthe Department of Neurosurgery, Huashan Hospital, hospital and surgical treatment. Ofwhich58patients received preoperative somatostatin analogues treatment, while other30patients did not receive drug treatment before surgery. According to the preoperativemedication patients were divided into two groups: treatment group and the untreated group.All the adenomas after surgery received immunohistochemical staining to evaluate theexpression of SSTR2and SSTR5.ResultsThere was no different of the expression of SSTR2and SSTR5between the twogroups; the expression level of SSTR2was positively correlated to the decrease anddecreased rate of IGF-1and tumor size (r=0.342,0.329,0.282, respectively, p <0.05); therewas no significant correlation with the growth hormone levels. SSTR5was notsignificantly correlated with above parameters.ConclusionThe use of somatostatin analogues has no significant effect on the expression ofSSTR2; the expression level of SSTR2was positively correlated with the drug sensitivity;SSTR2IRS could become one of the predictors of treatment efficacy in patients withsomatostatin analogues.