The prevalence of silent acromegaly in prolactinomas is very low

Abstract

Purpose

The aim of this study was to evaluate the somatotroph axis in a large series of patients with prolactinoma to verify the prevalence of silent acromegaly in this population.

Methods

A hundred and forty-four patients were enrolled in a multicenter study: 90 were already on cabergoline (CAB) and enrolled in a cross-sectional arm (group A) with random PRL, GH and IGF-I determination on treatment (≥ 3 months), whereas 54 untreated patients were enrolled at diagnosis in a prospective arm (group B) with PRL, GH and IGF-I measurement before and after 6 and 12 months of treatment. In the presence of high IGF-I, CAB was withdrawn for 3 months and GH, IGF-I, PRL and GH during an oral Glucose Tolerance Test (OGTT) were obtained.

Results

High IGF-I levels (ULN 1.01–1.56) were observed in 9 patients (6.25%, 5F). After CAB withdrawal, IGF-I levels normalized in 5/9 patients, GH was < 0.4 ng/ml after OGTT in 7/9 cases or at random GH determination in one case. After CAB re-introduction, IGF-I levels re-increased in a single case. Overall, a single young female patient harboring a macroadenoma in group A was diagnosed with silent acromegaly and underwent successful transsphenoidal removal of a GH/PRL-secreting adenoma.

Conclusion

The prevalence of silent acromegaly in prolactinomas (0.7%) is lower than previously reported and OGTT is helpful to recognize silent acromegaly. We suggest that the somatotroph axis should be evaluated at diagnosis in all cases and not systematically during follow-up.

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Funding

This research received grant from Ipsen Biopharmaceuticals (Protocol n. 359/2013).

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Correspondence to C. Bona.

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There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

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All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Bona, C., Prencipe, N., Jaffrain-Rea, M.L. et al. The prevalence of silent acromegaly in prolactinomas is very low. J Endocrinol Invest (2020). https://doi.org/10.1007/s40618-020-01338-x

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Keywords

  • Silent acromegaly
  • Prolactinoma
  • Dopamine agonists
  • Cabergoline