METHODS: 131 women and 138 men with a mean age of 53.8 years were included. Of these, 201 (74.7%) presented with a macroadenoma and 18 (6.7%) with a microadenoma. Radiographic invasion was present in 91 cases (33.8%). Mean
tumor diameter was 1.86 cm (0.2-4.6). Pituitary histopathologic findings revealed pure GH-producing
somatotroph adenomas (SA) in 147 patients,
prolactin-production by mixed lactotroph (LA) and SA or mammosomatotroph
adenoma (MSA) in 46 [22.4%], acidophil stem cell
adenoma in 6 [2.9%], and other diagnoses in 6 [2.9%]. Medical treatment included
octreotide in 96 [36.9%] and in combination with
pegvisomant or
dopamine agonists in 63 [24.2%]. Nearly 80% of patients achieved
IGF-1 normalization. Importantly, patients with pure
somatotroph adenomas were significantly more likely to present with abnormal
glucose metabolism [48.7%] than those with mixed
adenomas [9.7%] [p<0.001] independent of GH/IGF-1 levels or
tumor invasiveness. Abnormal
glucose metabolism and pituitary pathology also remained linked following
IGF-1 normalization. Moreover patients with pure SA and abnormal
glucose metabolism were significantly (p<0.001) less likely to achieve disease remission despite the same therapeutic strategies. Conversely, patients with mixed
adenomas were more likely (OR: 2.766 (95% CI: 1.490-5.136) to achieve disease remission.
CONCLUSIONS: