口服葡萄糖抑制生长激素试验不同反应的垂体GH瘤患者的临床特征

Clinical characteristics of pituitary GH adenomas patients with different responses to oral glucose inhibitory GH test

目的分析口服葡萄糖抑制生长激素(GH)试验不同反应的垂体GH瘤患者的临床特征。方法回顾性分析解放军总医院第一医学中心内分泌科2016年至2021年新诊断、有完整的口服葡萄糖抑制GH试验资料及病例资料的50例垂体GH瘤患者的临床资料。依据口服葡萄糖抑制GH试验任意时间GH升高到基础值的50%以上,将入选的50例垂体GH瘤患者分为2组:反常升高(A组)16例;无升高(B组)34例。分析2组间临床表现、生化、影像学及免疫组化检查结果。结果A组血清总胆固醇(TC)[(3.9±0.8)对(4.6±0.9)mmol/L]、糖负荷后120 min胰岛素[11.2(4.4,25.0)对92.0(10.8,311.8)mU/L]、垂体腺瘤长径[1.0(0.4,2.1)对1.5(0.5,7.3)cm],短径[0.6(0.3,1.3)对1.0(0.5,5.8)cm]均低于或短于B组(P<0.05),而血清胰岛素样生长因子Ⅰ(IGF-Ⅰ)高于B组[(908.2±233.7)对(743.1±273.1)ng/mL,P<0.05]。2组性别、年龄、病程、临床表现、随机GH、稳态模型评估的胰岛素抵抗指数(HOMA-IR)等生化指标、垂体腺瘤部位、侵袭性等差异均无统计学意义。A组免疫组化ACTH(33%对0%)、催乳素(100%对28.6%)阳性比例均高于B组(P<0.05)。结论口服葡萄糖抑制GH试验反常升高的垂体GH瘤患者血清TC、120 min胰岛素水平低,IGF-Ⅰ水平高,垂体微腺瘤占比高,"纯"GH瘤可能代表肢端肥大症中一类特殊疾病的实体。

Objective To analyzed clinical characteristics of pituitary growth hormone(GH)adenomas patients with different responses to oral glucose inhibitory GH test.Methods The clinical data of 50 patients with pituitary GH adenomas newly diagnosed with complete test data and case data in the Department of Endocrinology of Chinese PLA General Hospital was retrospectively analyzed from 2016 to 2021.The cases were divided into two groups according to the cutoff point of GH elevating to 50%of basaline during oral glucose test:abnormal elevation group(A group,n=16)and non-elevation group(B group,n=34).The clinical features,biochemistry,iconography,and immunohistochemistry of the two groups were analyzed.Results The serum total cholesterol(TC)[(3.9±0.8)vs(4.6±0.9)mmol/L],120 minutes insulin after glucose loading[11.2(4.4,25.0)vs 92.0(10.8,311.8)mU/L],long[1.0(0.4,2.1)vs 1.5(0.5,7.3)cm]and short[0.6(0.3,1.3)vs 1.0(0.5,5.8)cm]diameters of adenomas in A group were less than those in B group(all P<0.05)while insulin-like growth factorⅠ(IGF-Ⅰ)level was higher[(908.2±233.7)vs(743.1±273.1)ng/mL,P<0.05].There were no significant differences in sex,age,disease course,clinical features,random GH,homeostasis model assessment of insulin resistance index(HOMA-IR),pituitary adenoma site,and invasive properties between the two groups.The immunohistochemical positive rates of ACTH(33%vs 0%)and prolactin(100%vs 28.6%)in A group were higher than those in B group(P<0.05).Conclusion Pituitary GH adenomas patients with a paradoxical GH response pattern display lower serum TC and 120 minutes insulin levels as well as higher IGF-Ⅰconcentration and proportion of pituitary microadenomas."Pure"growth hormone tumors may represent entities of a particular class of diseases in acromegaly.