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Giant growth hormone-secreting pituitary adenomas from the endocrinologist’s perspective

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Abstract

Objectives

Since giant (≥40 mm) GH-secreting pituitary adenomas are rarely encountered, data on their characteristics and treatment outcomes are limited. We aimed to investigate the characteristics of giant GH-secreting pituitary adenomas and to compare their clinical, biochemical, imaging and histopathological features with non-giant macroadenomas.

Materials and methods

We have evaluated 15 (six female/nine male) and 57 (29 female/28 male) patients with acromegaly in giant and <40 mm adenoma groups, respectively. Patients with <40 mm adenoma were further divided into subgroups with adenoma size 20–29 mm and 30–39 mm.

Results

In giant adenoma group, median (IQR) preoperative maximal diameter of adenoma was 40 mm (5 mm), median preoperative GH level was 40 (153.4) ng/mL and median baseline IGF-1 level was 2.19 (1.88) × ULN for age and sex. The number of surgeries was significantly higher in giant adenoma group (median 2, IQR 2) in which 66.7% of patients underwent repeated surgeries (p = 0.014). Residual tumor was detected after last operation in all patients with giant adenoma. Total number of treatment modalities administered postoperatively increased as adenoma size increased (p = 0.043). After a median follow-up duration of 10 years (IQR 10), hormonal remission was achieved in six patients (40%) of giant adenoma group, while the rate of hormonal remission in non-giant adenoma group was 37%. Although preoperative GH and IGF-1 levels and Ki-67 index tended to be higher with increasing adenoma size, there was no statistically significant difference between groups in terms of these variables, as well as age, sex and invasion status.

Conclusion

Hormonal remission rates of acromegaly patients with ≥20 mm pituitary macroadenoma were comparable. However, giant GH-secreting pituitary adenomas require an aggressive multimodal treatment approach.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey

    Bahadir Koylu, Busra Firlatan, Suleyman Nahit Sendur, Seda Hanife Oguz, Selcuk Dagdelen & Tomris Erbas

  2. Department of Endocrinology and Metabolism, Hacettepe University School of Medicine, Ankara, Turkey

    Suleyman Nahit Sendur, Seda Hanife Oguz, Selcuk Dagdelen & Tomris Erbas

Authors
  1. Bahadir Koylu
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by B.K., B.F., and T.E. The first draft of the manuscript was written by B.K. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Bahadir Koylu.

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This study was performed in line with the principles of the Declaration of Helsinki and approved by Hacettepe University Ethics Committee (Approval ID: GO 18/973-06).

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Koylu, B., Firlatan, B., Sendur, S.N. et al. Giant growth hormone-secreting pituitary adenomas from the endocrinologist’s perspective. Endocrine 79, 545–553 (2023). https://doi.org/10.1007/s12020-022-03241-2

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