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Gender-Related Differences in Growth Hormone-Releasing Pituitary Adenomas. A Clinicopathological Study

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Abstract

Background/Aims: Pituitary adenomas are the third most common primary intracranial neoplasm, after astrocytomas and meningiomas, and about 30% of them secrete growth hormone (GH). Other subtypes of pituitary tumors are characterized by well-known gender-related differences, not only in clinical presentation and other biological characteristics but also in surgical outcome. For GH-releasing pituitary adenomas, however, detailed data on gender differences of postsurgical treatment are not available. Patients and methods: The patient charts of a series of 18 patients with acromegaly who met strict immunohistochemical and electron microscopic criteria and who underwent surgical resection of their tumors between January 1990 and June 1999 were retrospectively reviewed. Results: There were eight women and ten men; the male-to-female-ratio was 1.3:1. The men and women were equal in age at surgery. Men demonstrated higher IGF-1 and smaller GH levels pre- and postoperatively, whereas the reduction in IGF-1 was more pronounced compared to women (58% vs. 27%). The overall outcome was better in women than in men. Mixed GH- and prolactin-secreting adenomas showed a worse outcome among all other histological subtypes. Mitose- and MIB-1 labeling index was increased in men compared to women. Conclusion: The clinical course and tumor biology of GH-releasing pituitary adenomas appear to differ in women and men. Men demonstrated a shorter preoperative duration of symptoms, larger and more invasive tumors, and a worse clinical outcome. These findings suggest that therapy for GH-releasing adenomas should be more aggressive in men than in women. The gender-related differences in GH-releasing pituitary adenomas appear to have a basis in different biologic behavior, which warrants further investigation.

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References

  1. Mindermann T, Wilson CB. Pediatric pituitary adenomas. Neurosurgery 1995;36:259–269.

    Google Scholar 

  2. Melmed S. Acromegaly. N Engl J Med 1990;322:966–977.

    Google Scholar 

  3. Mindermann T, Wilson CB. Pituitary adenomas in childhood and adolescence. J Pediatr Endocrinol Metab 1995;8:79–83.

    Google Scholar 

  4. Arafah BM, Rosenzweig JL, Fenstermaker R, Salazar R, McBride CE, Selman W. Value of growth hormone dynamics and somatostatin C (insulin-like growth factor 1) levels in predicting the long-term benefit after transsphenoidal surgery for acromegaly. J Lab Clin Med 1987;109:346–354.

    Google Scholar 

  5. van Lindert E, Hey O, Boecher-Schwarz H, Perneczky A. Treatment results of acromegaly as analyzed by different criteria. Acta Neurochir (Wien) 1997;139:905–913.

    Google Scholar 

  6. Evans HM, Briggs JH, Dixon JS. The physiology and chemistry of growth hormone. In: Harris GW, Donovan BR, eds. The Pituitary Gland. Berkeley: University of California Press, 1966;1:439.

    Google Scholar 

  7. Minino AM, Arias E, Kochanek KD, Murphy SL, Smith BL. Deaths: Final data for 2000. Natl Vital Stat Rep 2002;50:1–119.

    Google Scholar 

  8. Abosch A, Tyrrell JB, Lamborn KR, Hannegan LT, Applebury CB, Wilson CB. Transsphenoidal microsurgery for growth hormone-secreting pituitary adenomas: Initial outcome and long-term results. J Clin Endocrinol Metab 1998;83:3411–3418.

    Google Scholar 

  9. Asa SL. Tumors of the pituitary gland. In: Atlas of Tumor Pathology. 3rd series, Fascicle 23. Armed Forces Institute of Pathology, Washington, DC, 1998.

    Google Scholar 

  10. Colao A, Ferone D, Cappabianca P, Laura M, de Caro B, Marzullo P, Monticelli A, Alfieri A, Merola B, Cali A, de Devitiis E, Lombardi G. Effect of octreotide pretreatment on surgical outcome in acromegaly. J Clin Endocrin Metab 1997;82:3308–3314.

    Google Scholar 

  11. Dons RF, Roseelet P, Pastakia B, Doppman J, Gorden P. Arthropathy in acromegalic patients before and after treatment: A long-term follow-up study. Clin Endocrinol (Oxf) 1988;28:515–524.

    Google Scholar 

  12. Frantz AG, Rabkin MT. Effects of estrogen and sex difference on secretion of human growth hormone. J Clin Endocrinol Metab 1965;25:1470–1480.

    Google Scholar 

  13. Freda PU, Wardlow SL, Post KD. Long-term endocrinological follow-up evaluation in 115 patients who underwent transsphenoidal surgery for acromegaly. J Neurosurg 1998;89:353–358.

    Google Scholar 

  14. Hardy J. Transsphenoidal microsurgery of the normal and pathological pituitary. Clin Neurosurg 1969;16:185–217.

    Google Scholar 

  15. Gatford KL, Egan AR, Clarke IJ, Owens PC. Sexual dimorphism of the somatotrophic axis. J Endocrinol 1998;157:373–389.

    Google Scholar 

  16. Ho KY, Evans WS, Blizzard RM, Veldhuis JD, Merriam GR, Samojlik E, Furlanetto R, Rogol AD, Kaiser DL, Thorner MO. Effects of sex and age on the 24-hour profile of growth hormone secretion in man: Importance of endogenous estradiol concentrations. J Clin Endocrinol Metab 1987;64:51–58.

    Google Scholar 

  17. Kovalic JJ, Mazoujian G, McKeel DW, Fineberg BB, Gringsby BW. Immunohisto-chemistry as a predictor of clinical outcome in patients given postoperative radiation for subtotally resected pituitary adenomas. J Neurooncol 1993;16:227–232.

    Google Scholar 

  18. Laws Er Jr. Neurosurgical management of acromegaly. In: Cooper PR, ed. Contemporary Diagnosis and Management of Pituitary Adenomas. Park Ridge, IL, American Association of Neurological Surgeons, 1990:53–59.

    Google Scholar 

  19. McLanahan CS, Christy JH, Tindall GT. Anterior pituitary function before and after transsphenoidal microsurgical resection of pituitary tumors. Neurosurgery 1978;3:142–145.

    Google Scholar 

  20. Liuzzi A, Oppizzi G. Evidence for octreotide subcutaneously in the treatment of acromegaly. J Endocrinol 1997;155:S61–S55.

    Google Scholar 

  21. Losa M, Oeckler R, Schopohl J, Muller OA, Alba-Lopez J, von Werder K. Evaluation of selective transphenoidal adenomectomy by endocrinological testing and somatomedin-C measurement in acromegaly. J Neurosurg 1989;70:561–567.

    Google Scholar 

  22. Melmed S. Medical management of acromegaly. What and when? Acta Endocrinol (Copenh) 1993;129:13–17.

    Google Scholar 

  23. Melmed S. Acromegaly. In: Melmed S, ed. The Pituitary. Cambridge, Blackwell Science, 1995:413–442.

    Google Scholar 

  24. Mindermann T, Wilson CB. Age-related and gender-related occurrence of pituitary adenomas. Clin Endocrinol (Oxf) 1994;41:359–364.

    Google Scholar 

  25. Molitch ME. Clinical manifestations of acromegaly. Endocrinol Metab Clin North Am 1992;21:597–614.

    Google Scholar 

  26. Nabarro JDN. Acromegaly. J Clin Endocrinol 1987;26:481–512.

    Google Scholar 

  27. Nyquist P, Laws ER Jr, Eliott E. Novel features of tumors that secrete both growth hormone and prolactin in acromegaly. Neurosurgery 1994;35:179–184.

    Google Scholar 

  28. Robert F, Pelletier G, Serri O, Hardy J. Mixed growth hormone and prolactin-secreting pituitary adenomas: A pathologic, immunocytochemical, ultrastructural, and immunoelectron microscopic study. Hum Pathol 1988;19:1327–1334.

    Google Scholar 

  29. Ross DA, Wilson CB. Results of transsphenoidal microsurgery for growth hormone-secreting pituitary adenoma in a series of 214 patients. J Neurosurg 1988;68:854–867.

    Google Scholar 

  30. Schaller B, Kirsch E, Tolnay M, Mindermann T. Symptomatic granular cell tumor of the pituitary. Case report and review of the literature. Neurosurgery 1998;42:166–171.

    Google Scholar 

  31. Schatz H, Stracke H, Hiltebrand G. Treatment of prolactinomas and growth-hormone-producing adenomas with an injectable bromocriptine retard preparation and a somatostatin analogue delivered by an implantable pump. Path Res Pract 1988;183:546–551.

    Google Scholar 

  32. Scheithauer B, Kovacs K, Laws ER, Randall R. Pathology of invasive pituitary tumors with special reference to functional classification. J Neurosurg 1986;65:733–744.

    Google Scholar 

  33. Thapar K, Kovacs K, Laws ER. Pituitary tumors. In: Black PM, Loeffler JS, eds. Cancer of the Nervous System. Cambridge, Blackwell Science, 1997:363–403.

    Google Scholar 

  34. Thomspon RG, Rodriguez A, Kowarski A, Blizzard RM. Growth hormone: Metabolic clearance rates, integrated concentrations, and production rates in normal adults and the effects of prednisone. J Clin Invest 1972;51:3193–3199.

    Google Scholar 

  35. Tindall GT, Oyesiku NM, Watt NB, Clark RV, Christy JH, Adams DA. Transsphenoidal adenomectomy for growth hormonesecreting pituitary adenomas in acromegaly: Outcome analysis and determinants of failure. J Neurosurg 1993;78:205–215.

    Google Scholar 

  36. van den Berg G, Veldhius JD, Frolich M, Roelfsema F. An amplitude-specific divergence in the pulsatile mode of growth hormone (GH) secretion underlines the gender difference in mean GH concentrations in men and premenopausal women. J Clin Endocrinaol Metab 1996;81:2460–2467.

    Google Scholar 

  37. Wilson CB. Surgical management of endocrine-active pituitary adenomas. In: Walker MD, ed. Oncology of the Nervous System. Boston, Martinus Nijhoff, 1983:117–150.

    Google Scholar 

  38. Winer LM, Shaw MA, Baumkann G. Basal plasma growth hormone levels in man: New evidence for rhythmicity of growth hormone secretion. J Clin Endocrinol Metab 1990;70:1678–1686.

    Google Scholar 

  39. Wright AD, Hill DM, Lowy C, Fraser TR. Mortality in acromegaly. Q J Med 1970;39:1–16.

    Google Scholar 

  40. Yamada S, Aiba T, Shishiba Y. Postoperative prognostic indicators on control of acromegaly. Surg Neurol 1989;31:14–19.

    Google Scholar 

  41. Zadik Z, Chalew SA, McCarter RJ Jr, Meistas M, Kowarski AA. The influence of age on the 24-hour integrated concentration of growth hormone in normal individuals. J Clin Endocrinol Metab 1985;60:513–516.

    Google Scholar 

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  1. Department of Neurology, Inselspital, Freiburgstrasse 10, CH-3010, Berne

    Bernhard Schaller

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Schaller, B. Gender-Related Differences in Growth Hormone-Releasing Pituitary Adenomas. A Clinicopathological Study. Pituitary 5, 247–253 (2002). https://doi.org/10.1023/A:1025329900839

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