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Abstract：
UNASSIGNED: Growth hormone (GH)/thyroid stimulating hormone (TSH) cosecreting pituitary adenoma (PA) is an exceedingly rare kind of bihormonal pituitary neuroendocrine tumors (PitNETs). Its clinical characteristics have rarely been reported.
UNASSIGNED: This study aimed to summarize the clinical characteristics and experience of diagnosis and treatment among patients with mixed GH/TSH PAs from a single center.
UNASSIGNED: We retrospectively reviewed GH/TSH cosecreting PAs from 2063 patients diagnosed with GH-secreting PAs admitted to Peking Union Medical College Hospital between January 1st, 2010, and August 30th, 2022, to investigate the clinical characteristics, hormone detection, imaging findings, treatment patterns and outcomes of follow-up. We further compared these mixed adenomas with age- and sex-matched cases of GH mono-secreting PAs (GHPAs). The data of the included subjects were collected using electronic records from the hospital\'s information system.
UNASSIGNED: Based on the inclusion and exclusion criteria, 21 GH/TSH cosecreting PAs were included. The average age of symptom onset was 41.6 ± 14.9 years old, and delayed diagnosis occurred in 57.1% (12/21) of patients. Thyrotoxicosis was the most common complaint (10/21, 47.6%). The median inhibition rates of GH and TSH in octreotide suppression tests were 79.1% [68.8%, 82.0%] and 94.7% [88.2%, 97.0%], respectively. All these mixed PAs were macroadenomas, and 23.8% (5/21) of them were giant adenomas. Comprehensive treatment strategies comprised of two or more therapy methods were applied in 66.7% (14/21) of patients. Complete remission of both GH and TSH was accomplished in one-third of cases. In the comparison with the matched GHPA subjects, the mixed GH/TSH group presented with a higher maximum diameter of the tumor (24.0 [15.0, 36.0] mm vs. 14.7 [10.8, 23.0] mm, P = 0.005), a greater incidence of cavernous sinus invasion (57.1% vs. 23.8%, P = 0.009) and a greater difficulty of long-term remission (28.6% vs. 71.4%, P <0.001). In addition, higher occurrence rates of arrhythmia (28.6% vs. 2.4%, P = 0.004), heart enlargement (33.3% vs. 4.8%, P = 0.005) and osteopenia/osteoporosis (33.3% vs. 2.4%, P = 0.001) were observed in the mixed PA group.
UNASSIGNED: There are great challenges in the treatment and management of GH/TSH cosecreting PA. Early diagnosis, multidisciplinary therapy and careful follow-up are required to improve the prognosis of this bihormonal PA.
UNASSIGNED: This study aimed to summarize the clinical characteristics and experience of diagnosis and treatment among patients with mixed GH/TSH PAs from a single center.
UNASSIGNED: We retrospectively reviewed GH/TSH cosecreting PAs from 2063 patients diagnosed with GH-secreting PAs admitted to Peking Union Medical College Hospital between January 1st, 2010, and August 30th, 2022, to investigate the clinical characteristics, hormone detection, imaging findings, treatment patterns and outcomes of follow-up. We further compared these mixed adenomas with age- and sex-matched cases of GH mono-secreting PAs (GHPAs). The data of the included subjects were collected using electronic records from the hospital\'s information system.
UNASSIGNED: Based on the inclusion and exclusion criteria, 21 GH/TSH cosecreting PAs were included. The average age of symptom onset was 41.6 ± 14.9 years old, and delayed diagnosis occurred in 57.1% (12/21) of patients. Thyrotoxicosis was the most common complaint (10/21, 47.6%). The median inhibition rates of GH and TSH in octreotide suppression tests were 79.1% [68.8%, 82.0%] and 94.7% [88.2%, 97.0%], respectively. All these mixed PAs were macroadenomas, and 23.8% (5/21) of them were giant adenomas. Comprehensive treatment strategies comprised of two or more therapy methods were applied in 66.7% (14/21) of patients. Complete remission of both GH and TSH was accomplished in one-third of cases. In the comparison with the matched GHPA subjects, the mixed GH/TSH group presented with a higher maximum diameter of the tumor (24.0 [15.0, 36.0] mm vs. 14.7 [10.8, 23.0] mm, P = 0.005), a greater incidence of cavernous sinus invasion (57.1% vs. 23.8%, P = 0.009) and a greater difficulty of long-term remission (28.6% vs. 71.4%, P <0.001). In addition, higher occurrence rates of arrhythmia (28.6% vs. 2.4%, P = 0.004), heart enlargement (33.3% vs. 4.8%, P = 0.005) and osteopenia/osteoporosis (33.3% vs. 2.4%, P = 0.001) were observed in the mixed PA group.
UNASSIGNED: There are great challenges in the treatment and management of GH/TSH cosecreting PA. Early diagnosis, multidisciplinary therapy and careful follow-up are required to improve the prognosis of this bihormonal PA.
摘要：
■生长激素（GH）/促甲状腺激素（TSH）共分泌垂体腺瘤（PA）是一种极为罕见的双激素垂体神经内分泌肿瘤（PitNETs）。其临床特点鲜有报道。
■本研究旨在总结单中心混合GH/TSHPAs患者的临床特征和诊治经验。
■我们回顾性地回顾了1月1日北京协和医院收治的2063名诊断为分泌GH的患者的GH/TSH共分泌PA，2010年8月30日,2022年，为了调查临床特征，激素检测，影像学发现，治疗模式和随访结果。我们进一步比较了这些混合腺瘤与年龄和性别匹配的GH单分泌PAs（GHPAs）病例。使用医院信息系统中的电子记录收集纳入受试者的数据。
■根据纳入和排除标准，包括21个共分泌GH/TSH的PA。平均发病年龄为41.6±14.9岁,57.1%(12/21)的患者出现延迟诊断。甲状腺毒症是最常见的主诉（10/21，47.6％）。奥曲肽抑制试验中GH和TSH的中位抑制率为79.1%[68.8%,82.0%]和94.7%[88.2%，97.0%]，分别。所有这些混合PA都是大腺瘤，其中23.8%(5/21)为巨大腺瘤。由两种或两种以上治疗方法组成的综合治疗策略在66.7%(14/21)的患者中应用。在三分之一的病例中，GH和TSH均完全缓解。在与匹配的GHPA受试者的比较中，混合GH/TSH组的肿瘤最大直径较高（24.0[15.0,36.0]mmvs.14.7[10.8,23.0]mm,P=0.005),海绵窦侵犯的发生率更高(57.1%vs.23.8%,P=0.009）和长期缓解的难度更大（28.6%vs.71.4%,P<0.001)。此外,心律失常发生率较高(28.6%vs.2.4%,P=0.004),心脏扩大（33.3%vs.4.8%，P=0.005）和骨质减少/骨质疏松症（33.3%vs.2.4%,在混合PA组中观察到P=0.001）。
■在GH/TSH共分泌PA的治疗和管理方面存在巨大挑战。早期诊断,需要多学科治疗和仔细的随访以改善这种双激素PA的预后。
■本研究旨在总结单中心混合GH/TSHPAs患者的临床特征和诊治经验。
■我们回顾性地回顾了1月1日北京协和医院收治的2063名诊断为分泌GH的患者的GH/TSH共分泌PA，2010年8月30日,2022年，为了调查临床特征，激素检测，影像学发现，治疗模式和随访结果。我们进一步比较了这些混合腺瘤与年龄和性别匹配的GH单分泌PAs（GHPAs）病例。使用医院信息系统中的电子记录收集纳入受试者的数据。
■根据纳入和排除标准，包括21个共分泌GH/TSH的PA。平均发病年龄为41.6±14.9岁,57.1%(12/21)的患者出现延迟诊断。甲状腺毒症是最常见的主诉（10/21，47.6％）。奥曲肽抑制试验中GH和TSH的中位抑制率为79.1%[68.8%,82.0%]和94.7%[88.2%，97.0%]，分别。所有这些混合PA都是大腺瘤，其中23.8%(5/21)为巨大腺瘤。由两种或两种以上治疗方法组成的综合治疗策略在66.7%(14/21)的患者中应用。在三分之一的病例中，GH和TSH均完全缓解。在与匹配的GHPA受试者的比较中，混合GH/TSH组的肿瘤最大直径较高（24.0[15.0,36.0]mmvs.14.7[10.8,23.0]mm,P=0.005),海绵窦侵犯的发生率更高(57.1%vs.23.8%,P=0.009）和长期缓解的难度更大（28.6%vs.71.4%,P<0.001)。此外,心律失常发生率较高(28.6%vs.2.4%,P=0.004),心脏扩大（33.3%vs.4.8%，P=0.005）和骨质减少/骨质疏松症（33.3%vs.2.4%,在混合PA组中观察到P=0.001）。
■在GH/TSH共分泌PA的治疗和管理方面存在巨大挑战。早期诊断,需要多学科治疗和仔细的随访以改善这种双激素PA的预后。
