Endocrine Abstracts

Introduction: Full blood count (FBC), C-reactive protein (CRP), albumin and serum inflammation-based scores reflect systemic inflammation and predict outcomes in oncological patients. While these are increasingly used in cancer, little is known in pituitary adenomas (PAs). We aimed to characterise FBC and inflammation-based scores in patients with PAs and investigate the usefulness of such parameters in predicting aggressive/refractory disease.

Methods: We studied 424 PA patients (68 prolactinomas, 72 acromegaly, 70 Cushing´s disease, 208 non-functioning PAs (NFPAs) and 6 thyrotrophinomas), as well as 47 craniopharyngiomas (CP) and Rathke’s cleft cysts (RCC). Patients who had first operation at our centre between 2006–2019 and available pre-operative biochemical data (FBC, CRP, albumin) were included. Patients with infection, malignancies, autoimmune or haematological conditions, and those on supraphysiological glucocorticoid doses at the time of blood test were excluded. The following scores were considered: Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Lymphocyte-to-Monocyte Ratio, Systemic Inflammation Index (SII), Neutrophil-Platelet Score (NPS), Prognostic Nutrition Index (PNI), and Glasgow Prognostic Score (GPS).

Results: PA patients had lower CRP, GPS, and higher PNI than CP/RCC patients. Cushing´s disease patients had higher mean platelet count, leucocytes, neutrophils and monocytes, and higher NLR, NPS and SII than other subtypes. FBC and inflammation based-scores didn’t differ among other non-Cushing’s subtypes. Serum prolactin correlated negatively with NLR among prolactinoma patients, while in acromegaly IGF-1 levels correlated positively with platelet count. Within Cushing´s disease, serum cortisol and ACTH correlated respectively with leucocyte count (positively); 24 h-urine cortisol levels correlated negatively with platelet, eosinophil and basophil counts, and were higher in patients with elevated CRP and GPS. Patients with functioning non-Cushing PAs and with suprasellar extension, cavernous sinus invasion, hypopituitarism and those requiring reoperation had higher GPS, while raised NPS was associated with suprasellar extension and active disease at last follow-up. Cushing´s patients with more invasive and refractory tumours had fewer platelets at diagnosis. NFPA patients who suffered apoplexy had more leucocytes, neutrophils and monocytes and higher CRP. NFPA patients suffering recurrence and requiring reoperation had fewer lymphocytes and higher PLR.

Conclusions: CP/RCC patients have higher systemic inflammation than PA patients. FBC and inflammation-based scores remarkably differ in Cushing´s disease comparing to other PA subtypes. The extent of pituitary hormone excess may influence, at least in part, the systemic inflammation in functioning PAs. Some inflammation-based scores may predict aggressive/refractory PA disease, namely GPS in functioning PAs (including Cushing´s disease), NPS in functioning non-Cushing PAs and PLR in NFPAs.