Introduction: Somatotropic adenomas are benign pituitary tumors characterized by increased GH and IGF1 levels. This study aims to describe the demographic, therapeutic, clinical, and evolutionary aspects of patients with somatotropic adenoma, along with a review of the literature. Patients and Method: This retrospective study was conducted in the neurosurgery department of the Fann National University Hospital Center over six years, from 2016 to 2022, covering 18 cases of acromegaly related to a GH adenoma. Sociodemographic, clinical, paraclinical, therapeutic, and evolutionary parameters were studied. Results: The average age was 42.8 years, with a sex ratio of 2, and an average diagnosis time of 5.27 years. Clinical diagnosis was suggested by dysmorphic and tumoral syndromes, then confirmed by biological data and imaging. We found one microadenoma, 11 macroadenomas, and six giant pituitary adenomas. All patients underwent transsphenoidal surgery. Complications were mainly transient diabetes insipidus. Postoperative assessments showed 13 total excisions, three residuals, 10 visual improvements, seven stable visual statuses, and 10 cases of hormonal remission. Conclusion: Acromegaly is a clinical manifestation of GH adenomas, which remain rare. We collected 18 cases of somatotropic adenoma, all operated on with good clinical, radiological, and hormonal outcomes.
References
[1]
Yahi, A., Haffaf, L. and Ouldkablia, S. (2015) Adénome silencieux à GH, à propos d’un cas. Annales d’Endocrinologie, 76, 406. https://doi.org/10.1016/j.ando.2015.07.341
[2]
Colao, A., Grasso, L.F.S., Giustina, A., Melmed, S., Chanson, P., Pereira, A.M., et al. (2019) Acromegaly. Nature Reviews Disease Primers, 5, Article No. 20. https://doi.org/10.1038/s41572-019-0071-6
[3]
Trivellin, G., Daly, A.F., Faucz, F.R., Yuan, B., Rostomyan, L., Larco, D.O., et al. (2014) Gigantism and Acromegaly Due to Xq26 Microduplications and GPR101 Mutation. New England Journal of Medicine, 371, 2363-2374. https://doi.org/10.1056/nejmoa1408028
[4]
Trainer, P.J., Drake, W.M., Katznelson, L., Freda, P.U., Herman-Bonert, V., van der Lely, A.J., et al. (2000) Treatment of Acromegaly with the Growth Hormone-Receptor Antagonist Pegvisomant. New England Journal of Medicine, 342, 1171-1177. https://doi.org/10.1056/nejm200004203421604
[5]
Chanson, P. and Kamenický, P. (2012) Traitement de l’acromégalie: Qu’ont apporté les dix dernières années? Une analyse critique. Annales d’Endocrinologie, 73, 99-106. https://doi.org/10.1016/j.ando.2012.03.034
[6]
Holdaway, I.M. and Rajasoorya, C. (1999) Epidemiology of Acromegaly. Pituitary, 2, 29-41. https://doi.org/10.1023/a:1009965803750
[7]
Petrossians, P., Daly, A.F., Natchev, E., Maione, L., Blijdorp, K., Sahnoun-Fathallah, M., et al. (2017) Acromegaly at Diagnosis in 3173 Patients from the Liège Acromegaly Survey (LAS) Database. Endocrine-Related Cancer, 24, 505-518. https://doi.org/10.1530/erc-17-0253
[8]
Melmed, S. (2006) Acromegaly. New England Journal of Medicine, 355, 2558-2573. https://doi.org/10.1056/nejmra062453
[9]
Chanson, P. and Salenave, S. (2008) Acromegaly. Orphanet Journal of Rare Diseases, 3, Article No. 17. https://doi.org/10.1186/1750-1172-3-17
[10]
Salem-Memou, S., Soumare, O., Mokhtar, A., Salihy, S.M., Kleib, A.S. and Abdelwedoud, M. (2018) Chirurgie endoscopique trans-sphénoïdale des adénomes hypophysaires en Mauritanie : étude préliminaire de 24 cas. Neurochirurgie, 64, 232-233. https://doi.org/10.1016/j.neuchi.2018.05.040
[11]
Hazer, D.B., Işık, S., Berker, D., Güler, S., Gürlek, A., Yücel, T., et al. (2013) Treatment of Acromegaly by Endoscopic Transsphenoidal Surgery: Surgical Experience in 214 Cases and Cure Rates According to Current Consensus Criteria. Journal of Neurosurgery, 119, 1467-1477. https://doi.org/10.3171/2013.8.jns13224
[12]
Day, P.F., Loto, M.G., Glerean, M., Picasso, M.F.R., Lovazzano, S. and Giunta, D.H. (2016) Incidence and Prevalence of Clinically Relevant Pituitary Adenomas: Retrospective Cohort Study in a Health Management Organization in Buenos Aires, Argentina. Archives of Endocrinology and Metabolism, 60, 554-561. https://doi.org/10.1590/2359-3997000000195
[13]
Ameziane Hassani, F., Imaouen, M., Salhi, H. and El Ouahabi, H. (2020) Le traitement par les analogues de la somatostatine chez le patient acromégale. Annales d'Endocrinologie, 81, 303. https://doi.org/10.1016/j.ando.2020.07.446
[14]
Cardinal, T., Collet, C., Wedemeyer, M., Singer, P.A., Weiss, M., Zada, G., et al. (2021) Postoperative GH and Degree of Reduction in IGF-1 Predicts Postoperative Hormonal Remission in Acromegaly. Frontiers in Endocrinology, 12, Article 743052. https://doi.org/10.3389/fendo.2021.743052
[15]
Cardinal, T., Rutkowski, M.J., Micko, A., Shiroishi, M., Jason Liu, C., Wrobel, B., et al. (2020) Impact of Tumor Characteristics and Pre-and Postoperative Hormone Levels on Hormonal Remission Following Endoscopic Transsphenoidal Surgery in Patients with Acromegaly. Neurosurgical Focus, 48, E10. https://doi.org/10.3171/2020.3.focus2080
[16]
Magro, E., Graillon, T., Lassave, J., Castinetti, F., Boissonneau, S., Tabouret, E., et al. (2016) Complications Related to the Endoscopic Endonasal Transsphenoidal Approach for Nonfunctioning Pituitary Macroadenomas in 300 Consecutive Patients. World Neurosurgery, 89, 442-453. https://doi.org/10.1016/j.wneu.2016.02.059
[17]
Pennacchietti, V., Garzaro, M., Grottoli, S., Pacca, P., Garbossa, D., Ducati, A., et al. (2016) Three-Dimensional Endoscopic Endonasal Approach and Outcomes in Sellar Lesions: A Single-Center Experience of 104 Cases. World Neurosurgery, 89, 121-125. https://doi.org/10.1016/j.wneu.2016.01.049
[18]
Karamouzis, I., Caputo, M., Mele, C., Nuzzo, A., Zavattaro, M., Car, P., et al. (2018) Transsphenoidal Surgery for Pituitary Adenomas: Early Results from a Single Center. Hormones, 17, 551-556. https://doi.org/10.1007/s42000-018-0082-9
[19]
Hima-Maiga, A., et al. (2021) Giant Pituitary Adenomas and Visual Disorders at Cliniques Saint-Luc (Brussels): Meaning and Evolution, a Review of 22 Patients. Health Sciences and Disease, 22, 3843.
[20]
Brue, T. (2009) ACROSTUDY: Status Update on 469 Patients. Hormone Research in Paediatrics, 71, 34-38. https://doi.org/10.1159/000178035
[21]
Hazer, D.B., Işık, S., Berker, D., Güler, S., Gürlek, A., Yücel, T., et al. (2013) Treatment of Acromegaly by Endoscopic Transsphenoidal Surgery: Surgical Experience in 214 Cases and Cure Rates According to Current Consensus Criteria. Journal of Neurosurgery, 119, 1467-1477. https://doi.org/10.3171/2013.8.jns13224
[22]
Gondim, J.A., Almeida, J.P., de Albuquerque, L.A.F., Gomes, E., Schops, M. and Ferraz, T. (2010) Pure Endoscopic Transsphenoidal Surgery for Treatment of Acromegaly: Results of 67 Cases Treated in a Pituitary Center. Neurosurgical Focus, 29, E7. https://doi.org/10.3171/2010.7.focus10167
[23]
Caron, P., Brue, T., Raverot, G., Tabarin, A., Cailleux, A., Delemer, B., et al. (2018) Signs and Symptoms of Acromegaly at Diagnosis: The Physician’s and the Patient’s Perspectives in the ACRO-POLIS Study. Endocrine, 63, 120-129. https://doi.org/10.1007/s12020-018-1764-4
[24]
Nachtigall, L., Delgado, A., Swearingen, B., Lee, H., Zerikly, R. and Klibanski, A. (2008) Extensive Clinical Experience: Changing Patterns in Diagnosis and Therapy of Acromegaly over Two Decades. The Journal of Clinical Endocrinology & Metabolism, 93, 2035-2041. https://doi.org/10.1210/jc.2007-2149
[25]
Benbow, S.J., Foy, P., Jones, B., Shaw, D. and MacFarlane, I.A. (1997) Pituitary Tumours Presenting in the Elderly: Management and Outcome. Clinical Endocrinology, 46, 657-660. https://doi.org/10.1046/j.1365-2265.1997.1180933.x
[26]
Kaidi, F.Z., El Aziz, S., Mjabber, A. and Chadli, A. (2018) Adénomes hypophysaires invasifs. Annales d’Endocrinologie, 79, 335. https://doi.org/10.1016/j.ando.2018.06.425
[27]
Banerjee, A., Patel, K. and Wren, A.M. (2003) Acromegaly-Clinical Manifestations and Diagnosis. The Pharmaceutical Journal, 13, 273-278.
[28]
Karppinen, A., Kivipelto, L., Vehkavaara, S., Ritvonen, E., Tikkanen, E., Kivisaari, R., et al. (2015) Transition from Microscopic to Endoscopic Transsphenoidal Surgery for Nonfunctional Pituitary Adenomas. World Neurosurgery, 84, 48-57. https://doi.org/10.1016/j.wneu.2015.02.024
[29]
Lugo, G., Pena, L. and Cordido, F. (2012) Clinical Manifestations and Diagnosis of Acromegaly. International Journal of Endocrinology, 2012, Article ID: 540398. https://doi.org/10.1155/2012/540398
[30]
Reid, T.J., Post, K.D., Bruce, J.N., Nabi Kanibir, M., Reyes‐Vidal, C.M. and Freda, P.U. (2010) Features at Diagnosis of 324 Patients with Acromegaly Did Not Change from 1981 to 2006: Acromegaly Remains Under-Recognized and Under-diagnosed. Clinical Endocrinology, 72, 203-208. https://doi.org/10.1111/j.1365-2265.2009.03626.x
[31]
Al Dallal, S. (2018) Acromegaly: A Challenging Condition to Diagnose. International Journal of General Medicine, 11, 337-343. https://doi.org/10.2147/ijgm.s169611
[32]
Bolanowski, M., Adnan, Z., Doknic, M., Guk, M., Hána, V., Ilovayskaya, I., et al. (2022) Acromegaly: Clinical Care in Central and Eastern Europe, Israel, and Kazakhstan. Frontiers in Endocrinology, 13, Article 816426. https://doi.org/10.3389/fendo.2022.816426
[33]
Maria, F., et al. (2022) Acromegaly: Pathogenesis, Diagnosis, and Management. The Lancet Diabetes & Endocrinology, 10, 804-826.
[34]
Syro, L.V., Rotondo, F., Serna, C.A., Ortiz, L.D. and Kovacs, K. (2016) Pathology of GH-Producing Pituitary Adenomas and GH Cell Hyperplasia of the Pituitary. Pituitary, 20, 84-92. https://doi.org/10.1007/s11102-016-0748-8
[35]
Varlamov, E.V., Wood, M.D., Netto, J.P., Thiessen, J., Kim, J., Lim, D.S.T., et al. (2020) Cystic Appearance on Magnetic Resonance Imaging in Bihormonal Growth Hormone and Prolactin Tumors in Acromegaly. Pituitary, 23, 672-680. https://doi.org/10.1007/s11102-020-01075-7
[36]
Jouanneau, E., Ladib, M., Charrière, S., Trouillas, J., Borson-chazot, F., Bernard, M., et al. (2005) P146-Résultats ophtalmologiques de la chirurgie hypophysaire dans les adenomes cliniquement non fonctionnels à partir d’une série de 183 patients. Annales d’Endocrinologie, 66, 462. https://doi.org/10.1016/s0003-4266(05)81987-0
[37]
Gondim, J.A., Almeida, J.P.C., Albuquerque, L.A.F., Gomes, E.F. and Schops, M. (2014) Giant Pituitary Adenomas: Surgical Outcomes of 50 Cases Operated on by the Endonasal Endoscopic Approach. World Neurosurgery, 82, e281-e290. https://doi.org/10.1016/j.wneu.2013.08.028
[38]
Turner, H., Adams, C. and Wass, J. (1999) Pituitary Tumours in the Elderly: A 20 Year Experience. European Journal of Endocrinology, 140, 383-389. https://doi.org/10.1530/eje.0.1400383
[39]
Torales, J., Halperin, I., Hanzu, F., Mora, M., Alobid, I., De Notaris, M., et al. (2014) Endoscopic Endonasal Surgery for Pituitary Tumors. Results in a Series of 121 Patients Operated at the Same Center and by the Same Neurosurgeon. Endocrinología y Nutrición (English Edition), 61, 410-416. https://doi.org/10.1016/j.endoen.2014.07.002
[40]
Rakik, N., Mohamed Elmoctar, S., Hadj Kacem, F., Ben Salah, D., Mnif, M., Mnif, F., et al. (2020) Résultats du traitement de l’acromégalie: A propos de 21 cas. Annales d’Endocrinologie, 81, 298. https://doi.org/10.1016/j.ando.2020.07.429
[41]
Carlsen, S.M., Svartberg, J., Schreiner, T., Aanderud, S., Johannesen, Ø., Skeie, S., et al. (2011) Six-Month Preoperative Octreotide Treatment in Unselected, De Novo Patients with Acromegaly: Effect on Biochemistry, Tumour Volume, and Postoperative Cure. Clinical Endocrinology, 74, 736-743. https://doi.org/10.1111/j.1365-2265.2011.03982.x
[42]
Fleseriu, M., Biller, B.M.K., Freda, P.U., Gadelha, M.R., Giustina, A., Katznelson, L., et al. (2020) A Pituitary Society Update to Acromegaly Management Guidelines. Pituitary, 24, 1-13. https://doi.org/10.1007/s11102-020-01091-7
[43]
Pasche, P. (2020) Endoscopic Skull Base Surgery in the ENT and Head and Neck Surgery Department. https://www.chuv.ch
[44]
Fleseriu, M., Hamrahian, A.H., Hoffman, A.R., Kelly, D.F. and Katznelson, L. (2016) American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: Diagnosis of Recurrence in Cushing Disease. Endocrine Practice, 22, 1436-1448. https://doi.org/10.4158/ep161512.dscr
[45]
Little, A.S., Kelly, D., Milligan, J., Griffiths, C., Prevedello, D.M., Carrau, R.L., et al. (2015) Predictors of Sinonasal Quality of Life and Nasal Morbidity after Fully Endoscopic Transsphenoidal Surgery. Journal of Neurosurgery, 122, 1458-1465. https://doi.org/10.3171/2014.10.jns141624
[46]
Kebira, A. (2003) Non-Secreting Pituitary Adenomas. Ph.D. Thesis, Casablanca University.
[47]
Gaillard, S., et al. (2012) Endoscopic Surgery for Pituitary Adenomas. Correspondancesen MHND, 16, 231-235.
[48]
Berker, M., Hazer, D.B., Yücel, T., Gürlek, A., Cila, A., Aldur, M., et al. (2011) Complications of Endoscopic Surgery of the Pituitary Adenomas: Analysis of 570 Patients and Review of the Literature. Pituitary, 15, 288-300. https://doi.org/10.1007/s11102-011-0368-2
[49]
Frank, G., Pasquini, E., Farneti, G., Mazzatenta, D., Sciarretta, V., Grasso, V., et al. (2006) The Endoscopic versus the Traditional Approach in Pituitary Surgery. Neuroendocrinology, 83, 240-248. https://doi.org/10.1159/000095534
[50]
Wang, F., Zhou, T., Wei, S., Meng, X., Zhang, J., Hou, Y., et al. (2014) Endoscopic Endonasal Transsphenoidal Surgery of 1,166 Pituitary Adenomas. Surgical Endoscopy, 29, 1270-1280. https://doi.org/10.1007/s00464-014-3815-0
[51]
Duntze, J., et al. (2012) Cerebrospinal Rhinorrhea after Endoscopic Trans-Sphenoidal Pituitary Surgery: Reflections after 337 Patients. Neurosurgery, 58, 241-245.
[52]
Roux, X., Page, P., Nataf, F., Devaux, B. and Joly, L.M. (2002) Interest in the Endonasal Approach for the Excision of Pituitary Adenomas. Annales d’endocrinologie Paris, 63, 187-192.
[53]
Gaillard, S. and Aniba, K. (2014) Neurosurgical Aspects of Pituitary Adenomas. Endocrinology-Nutrition, 7, Article 292681.
[54]
Ciric, I., Ragin, A., Baumgartner, C. and Pierce, D. (1997) Complications of Transsphenoidal Surgery: Results of a National Survey, Review of the Literature, and Personal Experience. Neurosurgery, 40, 225-237. https://doi.org/10.1097/00006123-199702000-00001
[55]
Moussa Baldé, N., Ben Yaya, M., Poirier, J.Y., Mansour Diallo, M., Lorcy, Y., Car-sin-Nicol, B. and Mo, X. (2008) Long-Term Prognosis of Non-Functional Pituitary Adenomas Operated by Transsphenoidal Route. Annales d’Endocrinologie, 67, 416.
[56]
Ding, D., Mehta, G.U., Patibandla, M.R., Lee, C.C., Liscak, R., Kano, H., et al. (2018) Stereotactic Radiosurgery for Acromegaly: An International Multicenter Retrospective Cohort Study. Neurosurgery, 84, 717-725.
