Endocrine Abstracts

Introduction: Amenorrhoea and galactorrhoea are manifestations that may allow earlier diagnosis of pituitary tumors associated with excess somatotropin (ST) and prolactin (PRL) levels.

Objective: To evaluate clinical, analytical and imaging characteristics of ST and PRL producing tumors and its affect on diagnosis.

Methods: Retrospective study including acromegalic patients diagnosed between 1982 and 2012. Information on clinical, analytical and imaging parameters was collected. For statistical analysis independent samples t-test, Mann–Whitney and χ² tests as well as partial correlations were used.

Results: We evaluated 98 patients (69.4% women, n=68) with mean age at diagnosis of 45.4±14.6 years and diagnostic delay of 6.8±5.3 years. We compared patients with isolated hypersecretion of ST and patients with concomitant hypersecretion of PRL and ST (36.7%, n=36; PRL levels of 10.8±5.4 vs 78.0±80.1 ng/ml; P<0.001). Patients with PRL secretion showed earlier diagnosis (5.1±4.1 vs 7.6±5.8 years, P=0.021) and were younger at diagnosis (40.3±14.9 vs 48.7±14.0 years, P=0.009). No correlation was found between the delay in diagnosis and prolactin levels after controlling for age at diagnosis (r=−0.085, P=0.454). There were no differences in body mass index (28.4±4.8 vs 28.9±6.1 kg/m², P=0.678), tumor size (19.3±13.4 vs 15.2±7.8 mm, P=0.328), ST nadir (19.8±25.5 vs 19.5±21.3 ng/ml, P=0.959), IGF1 levels (expressed as a percentage of the upper limit of normal), FSH or LH. No differences were found regarding clinical manifestations or symptoms. When evaluated independently, women and men, we found a higher prevalence of galactorrhea in women with PRL-producing tumors (14.3 vs 4.1%, P=0.001). When evaluated only premenopausal women (n=19) we found no differences between the two groups except for the levels of PRL.

Discussion: Tumors with hypersecretion ST and PRL are associated with earlier diagnosis comparing with tumors producing only ST. The shortest time to diagnosis seems especially related to age at diagnosis and not with PRL levels.