Abstract
Certain clinical conditions and markers have recently been demonstrated to modify the natural history of acromegaly in affected patients. Thus, some clinical, histological, radiological and molecular factors are associated with more aggressive pituitary tumors that have higher biochemical activity, higher tumor volumes and decreased tumoral and biochemical responses to current therapies. However, these factors do not seem to have an equal influence on the prognosis of patients with acromegaly. We present a review of the factors that influence the clinical course of patients with acromegaly and propose a risk value for each factor that will allow prognostic scoring for affected patients by considering a combination of these factors.
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References
Dekkers OM, Biermasz NR, Pereira AM, Romijn JA, Vandenbroucke JP (2008) Mortality in acromegaly: a metaanalysis. J Clin Endocrinol Metab 93(1):61–67. doi:10.1210/jc.2007-1191
Ayuk J, Clayton RN, Holder G, Sheppard MC, Stewart PM, Bates AS (2004) Growth hormone and pituitary radiotherapy, but not serum insulin-like growth factor-I concentrations, predict excess mortality in patients with acromegaly. J Clin Endocrinol Metab 89(4):1613–1617
Lundin P, Eden Engstrom B, Karlsson FA, Burman P (1997) Long-term octreotide therapy in growth hormone-secreting pituitary adenomas: evaluation with serial MR. AJNR Am J Neuroradiol 18(4):765–772
Ezzat S, Forster MJ, Berchtold P, Redelmeier DA, Boerlin V, Harris AG (1994) Acromegaly. Clinical and biochemical features in 500 patients. Medicine (Baltimore) 73(5):233–240
van der Lely AJ, Harris AG, Lamberts SW (1992) The sensitivity of growth hormone secretion to medical treatment in acromegalic patients: influence of age and sex. Clin Endocrinol (Oxf) 37(2):181–185
Nomikos P, Buchfelder M, Fahlbusch R (2005) The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical ‘cure’. Eur J Endocrinol 152(3):379–387. doi:10.1530/eje.1.01863
Abosch A, Tyrrell JB, Lamborn KR, Hannegan LT, Applebury CB, Wilson CB (1998) Transsphenoidal microsurgery for growth hormone-secreting pituitary adenomas: initial outcome and long-term results. J Clin Endocrinol Metab 83(10):3411–3418
Freda PU, Landman RE, Sundeen RE, Post KD (2001) Gender and age in the biochemical assessment of cure of acromegaly. Pituitary 4(3):163–171
Parkinson C, Ryder WD, Trainer PJ (2001) The relationship between serum GH and serum IGF-I in acromegaly is gender-specific. J Clin Endocrinol Metab 86(11):5240–5244
Bando H, Sano T, Ohshima T, Zhang CY, Yamasaki R, Matsumoto K, Saito S (1992) Differences in pathological findings and growth hormone responses in patients with growth hormone-producing pituitary adenoma. Endocrinol Jpn 39(4):355–363
Asa SL, Coschigano KT, Bellush L, Kopchick JJ, Ezzat S (2000) Evidence for growth hormone (GH) autoregulation in pituitary somatotrophs in GH antagonist-transgenic mice and GH receptor-deficient mice. Am J Pathol 156(3):1009–1015. doi:10.1016/S0002-9440(10)64968-1
Barlier A, Gunz G, Zamora AJ, Morange-Ramos I, Figarella-Branger D, Dufour H, Enjalbert A, Jaquet P (1998) Pronostic and therapeutic consequences of Gs alpha mutations in somatotroph adenomas. J Clin Endocrinol Metab 83(5):1604–1610
Asa SL, Digiovanni R, Jiang J, Ward ML, Loesch K, Yamada S, Sano T, Yoshimoto K, Frank SJ, Ezzat S (2007) A growth hormone receptor mutation impairs growth hormone autofeedback signaling in pituitary tumors. Cancer Res 67(15):7505–7511. doi:10.1158/0008-5472.CAN-07-0219
Frank SJ, Fuchs SY (2008) Modulation of growth hormone receptor abundance and function: roles for the ubiquitin–proteasome system. Biochim Biophys Acta 1782(12):785–794. doi:10.1016/j.bbadis.2008.06.001
van der Lely AJ, Biller BM, Brue T, Buchfelder M, Ghigo E, Gomez R, Hey-Hadavi J, Lundgren F, Rajicic N, Strasburger CJ, Webb SM, Koltowska-Haggstrom M (2012) Long-term safety of pegvisomant in patients with acromegaly: comprehensive review of 1288 subjects in ACROSTUDY. J Clin Endocrinol Metab 97(5):1589–1597. doi:10.1210/jc.2011-2508
Hagiwara A, Inoue Y, Wakasa K, Haba T, Tashiro T, Miyamoto T (2003) Comparison of growth hormone-producing and non-growth hormone-producing pituitary adenomas: imaging characteristics and pathologic correlation. Radiology 228(2):533–538. doi:10.1148/radiol.2282020695
Puig-Domingo M, Resmini E, Gomez-Anson B, Nicolau J, Mora M, Palomera E, Marti C, Halperin I, Webb SM (2010) Magnetic resonance imaging as a predictor of response to somatostatin analogs in acromegaly after surgical failure. J Clin Endocrinol Metab 95(11):4973–4978. doi:10.1210/jc.2010-0573
Turner HE, Wass JA (1999) Are markers of proliferation valuable in the histological assessment of pituitary tumours? Pituitary 1(3–4):147–151
Thapar K, Kovacs K, Scheithauer BW, Stefaneanu L, Horvath E, Pernicone PJ, Murray D, Laws ER Jr. (1996) Proliferative activity and invasiveness among pituitary adenomas and carcinomas: an analysis using the MIB-1 antibody. Neurosurgery 38(1):99–106; discussion 106–107
Fusco A, Zatelli MC, Bianchi A, Cimino V, Tilaro L, Veltri F, Angelini F, Lauriola L, Vellone V, Doglietto F, Ambrosio MR, Maira G, Giustina A, degli Uberti EC, Pontecorvi A, De Marinis L (2008) Prognostic significance of the Ki-67 labeling index in growth hormone-secreting pituitary adenomas. J Clin Endocrinol Metab 93(7):2746–2750. doi:10.1210/jc.2008-0126
Mazal PR, Czech T, Sedivy R, Aichholzer M, Wanschitz J, Klupp N, Budka H (2001) Prognostic relevance of intracytoplasmic cytokeratin pattern, hormone expression profile, and cell proliferation in pituitary adenomas of akromegalic patients. Clin Neuropathol 20(4):163–171
Jaffrain-Rea ML, Di Stefano D, Minniti G, Esposito V, Bultrini A, Ferretti E, Santoro A, Faticanti Scucchi L, Gulino A, Cantore G (2002) A critical reappraisal of MIB-1 labelling index significance in a large series of pituitary tumours: secreting versus non-secreting adenomas. Endocr Relat Cancer 9(2):103–113
DeLellis RA, Lloyd RV, Heitz PU, End C (eds) (2004) World Health Organization classification of tumors: tumours of endocrine organs. In: pp 10–47. IARC, Lyon
Gejman R, Swearingen B, Hedley-Whyte ET (2008) Role of Ki-67 proliferation index and p53 expression in predicting progression of pituitary adenomas. Hum Pathol 39(5):758–766. doi:10.1016/j.humpath.2007.10.004
Hentschel SJ, McCutcheon E, Moore W, Durity FA (2003) P53 and MIB-1 immunohistochemistry as predictors of the clinical behavior of nonfunctioning pituitary adenomas. Can J Neurol Sci 30(3):215–219
Honegger J, Prettin C, Feuerhake F, Petrick M, Schulte-Monting J, Reincke M (2003) Expression of Ki-67 antigen in nonfunctioning pituitary adenomas: correlation with growth velocity and invasiveness. J Neurosurg 99(4):674–679. doi:10.3171/jns.2003.99.4.0674
Pei L, Melmed S, Scheithauer B, Kovacs K, Prager D (1994) H-ras mutations in human pituitary carcinoma metastases. J Clin Endocrinol Metab 78(4):842–846
Pei L, Melmed S, Scheithauer B, Kovacs K, Benedict WF, Prager D (1995) Frequent loss of heterozygosity at the retinoblastoma susceptibility gene (RB) locus in aggressive pituitary tumors: evidence for a chromosome 13 tumor suppressor gene other than RB. Cancer Res 55(8):1613–1616
Bates AS, Farrell WE, Bicknell EJ, McNicol AM, Talbot AJ, Broome JC, Perrett CW, Thakker RV, Clayton RN (1997) Allelic deletion in pituitary adenomas reflects aggressive biological activity and has potential value as a prognostic marker. J Clin Endocrinol Metab 82(3):818–824
Yarman S, Kurtulmus N, Canbolat A, Bayindir C, Bilgic B, Ince N (2010) Expression of Ki-67, p53 and vascular endothelial growth factor (VEGF) concomitantly in growth hormone-secreting pituitary adenomas; which one has a role in tumor behavior? Neuro Endocrinol Lett 31(6):823–828
Thapar K, Kovacs K, Stefaneanu L, Scheithauer B, Killinger DW, Lioyd RV, Smyth HS, Barr A, Thorner MO, Gaylinn B, Laws ER Jr (1997) Overexpression of the growth-hormone-releasing hormone gene in acromegaly-associated pituitary tumors. An event associated with neoplastic progression and aggressive behavior. Am J Pathol 151(3):769–784
Daly AF, Tichomirowa MA, Petrossians P, Heliovaara E, Jaffrain-Rea ML, Barlier A, Naves LA, Ebeling T, Karhu A, Raappana A, Cazabat L, De Menis E, Montanana CF, Raverot G, Weil RJ, Sane T, Maiter D, Neggers S, Yaneva M, Tabarin A, Verrua E, Eloranta E, Murat A, Vierimaa O, Salmela PI, Emy P, Toledo RA, Sabate MI, Villa C, Popelier M, Salvatori R, Jennings J, Longas AF, Labarta Aizpun JI, Georgitsi M, Paschke R, Ronchi C, Valimaki M, Saloranta C, De Herder W, Cozzi R, Guitelman M, Magri F, Lagonigro MS, Halaby G, Corman V, Hagelstein MT, Vanbellinghen JF, Barra GB, Gimenez-Roqueplo AP, Cameron FJ, Borson-Chazot F, Holdaway I, Toledo SP, Stalla GK, Spada A, Zacharieva S, Bertherat J, Brue T, Bours V, Chanson P, Aaltonen LA, Beckers A (2010) Clinical characteristics and therapeutic responses in patients with germ-line AIP mutations and pituitary adenomas: an international collaborative study. J Clin Endocrinol Metab 95(11):E373–E383. doi:10.1210/jc.2009-2556
Williams F, Hunter S, Bradley L, Chahal HS, Storr H, Akker SA, Kumar AV, Orme SM, Evanson J, Morrison PJ, Korbonits M, Atkinson AB (2013) Clinical experience in the screening and management of a large kindred with familial isolated pituitary adenoma due to an aryl hydrocarbon receptor interacting protein (AIP) mutation. J Clin Endocrinol Metab, jc20132868. doi:10.1210/jc.2013-2868
Zhang X, Horwitz GA, Heaney AP, Nakashima M, Prezant TR, Bronstein MD, Melmed S (1999) Pituitary tumor transforming gene (PTTG) expression in pituitary adenomas. J Clin Endocrinol Metab 84(2):761–767
Noh TW, Jeong HJ, Lee MK, Kim TS, Kim SH, Lee EJ (2009) Predicting recurrence of nonfunctioning pituitary adenomas. J Clin Endocrinol Metab 94(11):4406–4413. doi:10.1210/jc.2009-0471
Filippella M, Galland F, Kujas M, Young J, Faggiano A, Lombardi G, Colao A, Meduri G, Chanson P (2006) Pituitary tumour transforming gene (PTTG) expression correlates with the proliferative activity and recurrence status of pituitary adenomas: a clinical and immunohistochemical study. Clin Endocrinol (Oxf) 65(4):536–543. doi:10.1111/j.1365-2265.2006.02630.x
Sanchez-Tejada L, Sanchez-Ortiga R, Moreno-Perez O, Montanana CF, Niveiro M, Tritos NA, Alfonso AM (2013) Pituitary tumor transforming gene and insulin-like growth factor 1 receptor expression and immunohistochemical measurement of Ki-67 as potential prognostic markers of pituitary tumors aggressiveness. Endocrinol Nutr 60(7):358–367. doi:10.1016/j.endonu.2012.09.005
Asa SL, Ezzat S (2002) The pathogenesis of pituitary tumours. Nat Rev Cancer 2(11):836–849. doi:10.1038/nrc926
Wang Z, Melmed S (2000) Pituitary tumor transforming gene (PTTG) transforming and transactivation activity. J Biol Chem 275(11):7459–7461
Salehi F, Kovacs K, Scheithauer BW, Lloyd RV, Cusimano M (2008) Pituitary tumor-transforming gene in endocrine and other neoplasms: a review and update. Endocr Relat Cancer 15(3):721–743. doi:10.1677/ERC-08-0012
Pantel J, Machinis K, Sobrier ML, Duquesnoy P, Goossens M, Amselem S (2000) Species-specific alternative splice mimicry at the growth hormone receptor locus revealed by the lineage of retroelements during primate evolution. J Biol Chem 275(25):18664–18669. doi:10.1074/jbc.M001615200
Schmid C, Krayenbuehl PA, Bernays RL, Zwimpfer C, Maly FE, Wiesli P (2007) Growth hormone (GH) receptor isoform in acromegaly: lower concentrations of GH but not insulin-like growth factor-1 in patients with a genomic deletion of exon 3 in the GH receptor gene. Clin Chem 53(8):1484–1488. doi:10.1373/clinchem.2007.085712
Mercado M, Gonzalez B, Sandoval C, Esquenazi Y, Mier F, Vargas G, de los Monteros AL, Sosa E (2008) Clinical and biochemical impact of the d3 growth hormone receptor genotype in acromegaly. J Clin Endocrinol Metab 93(9):3411–3415. doi:10.1210/jc.2008-0391
Wassenaar MJ, Biermasz NR, Pereira AM, van der Klaauw AA, Smit JW, Roelfsema F, van der Straaten T, Cazemier M, Hommes DW, Kroon HM, Kloppenburg M, Guchelaar HJ, Romijn JA (2009) The exon-3 deleted growth hormone receptor polymorphism predisposes to long-term complications of acromegaly. J Clin Endocrinol Metab 94(12):4671–4678. doi:10.1210/jc.2009-1172
Filopanti M, Olgiati L, Mantovani G, Corbetta S, Arosio M, Gasco V, De Marinis L, Martini C, Bogazzi F, Cannavo S, Colao A, Ferone D, Arnaldi G, Pigliaru F, Peri A, Angeletti G, Jaffrain-Rea ML, Lania AG, Spada A (2012) Growth hormone receptor variants and response to pegvisomant in monotherapy or in combination with somatostatin analogs in acromegalic patients: a multicenter study. J Clin Endocrinol Metab 97(2):E165–E172. doi:10.1210/jc.2011-1769
Rosen CJ, Kurland ES, Vereault D, Adler RA, Rackoff PJ, Craig WY, Witte S, Rogers J, Bilezikian JP (1998) Association between serum insulin growth factor-I (IGF-I) and a simple sequence repeat in IGF-I gene: implications for genetic studies of bone mineral density. J Clin Endocrinol Metab 83(7):2286–2290
Vaessen N, Heutink P, Janssen JA, Witteman JC, Testers L, Hofman A, Lamberts SW, Oostra BA, Pols HA, van Duijn CM (2001) A polymorphism in the gene for IGF-I: functional properties and risk for type 2 diabetes and myocardial infarction. Diabetes 50(3):637–642
Vaessen N, Janssen JA, Heutink P, Hofman A, Lamberts SW, Oostra BA, Pols HA, van Duijn CM (2002) Association between genetic variation in the gene for insulin-like growth factor-I and low birthweight. Lancet 359(9311):1036–1037. doi:10.1016/S0140-6736(02)08067-4
Bleumink GS, Rietveld I, Janssen JA, van Rossum EF, Deckers JW, Hofman A, Witteman JC, van Duijn CM, Stricker BH (2004) Insulin-like growth factor-I gene polymorphism and risk of heart failure (the Rotterdam Study). Am J Cardiol 94(3):384–386. doi:10.1016/j.amjcard.2004.04.044
Miletta MC, Scheidegger UA, Giordano M, Bozzola M, Pagani S, Bona G, Dattani M, Hindmarsh PC, Petkovic V, Oser-Meier M, Fluck CE, Mullis PE (2012) Association of the (CA)n repeat polymorphism of insulin-like growth factor-I and -202 A/C IGF-binding protein-3 promoter polymorphism with adult height in patients with severe growth hormone deficiency. Clin Endocrinol (Oxf) 76(5):683–690. doi:10.1111/j.1365-2265.2011.04267.x
Akin F, Turgut S, Cirak B, Kursunluoglu R (2010) IGF(CA)19 and IGFBP-3-202A/C gene polymorphism in patients with acromegaly. Growth Horm IGF Res 20(6):399–403. doi:10.1016/j.ghir.2010.09.001
Giustina A, Bronstein MD, Casanueva FF, Chanson P, Ghigo E, Ho KK, Klibanski A, Lamberts S, Trainer P, Melmed S (2011) Current management practices for acromegaly: an international survey. Pituitary 14(2):125–133. doi:10.1007/s11102-010-0269-9
Ahmed S, Elsheikh M, Stratton IM, Page RC, Adams CB, Wass JA (1999) Outcome of transphenoidal surgery for acromegaly and its relationship to surgical experience. Clin Endocrinol (Oxf) 50(5):561–567. doi:10.1046/j.1365-2265.1999.00760.x
Kreutzer J, Vance ML, Lopes MB, Laws ER Jr (2001) Surgical management of GH-secreting pituitary adenomas: an outcome study using modern remission criteria. J Clin Endocrinol Metab 86(9):4072–4077
De P, Rees DA, Davies N, John R, Neal J, Mills RG, Vafidis J, Davies JS, Scanlon MF (2003) Transsphenoidal surgery for acromegaly in wales: results based on stringent criteria of remission. J Clin Endocrinol Metab 88(8):3567–3572
Beauregard C, Truong U, Hardy J, Serri O (2003) Long-term outcome and mortality after transsphenoidal adenomectomy for acromegaly. Clin Endocrinol (Oxf) 58(1):86–91. doi:10.1046/j.1365-2265.2003.01679.x
Salaun C, Foubert L, Vialatou M, Kujas M, Turpin G (1999) Prognostic factors in the surgical management of acromegaly. Ann Med Intern (Paris) 150(3):195–198
Bevan JS, Atkin SL, Atkinson AB, Bouloux PM, Hanna F, Harris PE, James RA, McConnell M, Roberts GA, Scanlon MF, Stewart PM, Teasdale E, Turner HE, Wass JA, Wardlaw JM (2002) Primary medical therapy for acromegaly: an open, prospective, multicenter study of the effects of subcutaneous and intramuscular slow-release octreotide on growth hormone, insulin-like growth factor-I, and tumor size. J Clin Endocrinol Metab 87(10):4554–4563
Abe T, Sanno N, Osamura YR, Matsumoto K (1997) Proliferative potential in pituitary adenomas: measurement by monoclonal antibody MIB-1. Acta Neurochir (Wien) 139(7):613–618
Ekramullah SM, Saitoh Y, Arita N, Ohnishi T, Hayakawa T (1996) The correlation of Ki-67 staining indices with tumour doubling times in regrowing non-functioning pituitary adenomas. Acta Neurochir (Wien) 138(12):1449–1455
Losa M, Franzin A, Mangili F, Terreni MR, Barzaghi R, Veglia F, Mortini P, Giovanelli M (2000) Proliferation index of nonfunctioning pituitary adenomas: correlations with clinical characteristics and long-term follow-up results. Neurosurgery 47(6):1313–1318; discussion 1318–1319
Carlsen SM, Lund-Johansen M, Schreiner T, Aanderud S, Johannesen O, Svartberg J, Cooper JG, Hald JK, Fougner SL, Bollerslev J (2008) Preoperative octreotide treatment in newly diagnosed acromegalic patients with macroadenomas increases cure short-term postoperative rates: a prospective, randomized trial. J Clin Endocrinol Metab 93(8):2984–2990. doi:10.1210/jc.2008-0315
Mao ZG, Zhu YH, Tang HL, Wang DY, Zhou J, He DS, Lan H, Luo BN, Wang HJ (2010) Preoperative lanreotide treatment in acromegalic patients with macroadenomas increases short-term postoperative cure rates: a prospective, randomised trial. Eur J Endocrinol 162(4):661–666. doi:10.1530/EJE-09-0908
Shen M, Shou X, Wang Y, Zhang Z, Wu J, Mao Y, Li S, Zhao Y (2010) Effect of presurgical long-acting octreotide treatment in acromegaly patients with invasive pituitary macroadenomas: a prospective randomized study. Endocr J 57(12):1035–1044. doi:10.1507/endocrj.K10E-203
Colao A, Bronstein M, Freda P, Gu F, Shen CC, Gadelha M, Fleseriu M, van der Lely A, Farrall A, Hermosillo Resendiz K, Ruffin M, Chen Y, Sheppard M (2014) Pasireotide versus octreotide in acromegaly: a head-to-head superiority study. J Clin Endocrinol Metab, jc20132480. doi:10.1210/jc.2013-2480
Freda PU (2002) Somatostatin analogs in acromegaly. J Clin Endocrinol Metab 87(7):3013–3018
Bevan JS (2005) Clinical review: the antitumoral effects of somatostatin analog therapy in acromegaly. J Clin Endocrinol Metab 90(3):1856–1863. doi:10.1210/jc.2004-1093
Arosio M, Macchelli S, Rossi CM, Casati G, Biella O, Faglia G (1995) Effects of treatment with octreotide in acromegalic patients—a multicenter Italian study. Italian Multicenter Octreotide Study Group. Eur J Endocrinol 133(4):430–439
Ezzat S, Snyder PJ, Young WF, Boyajy LD, Newman C, Klibanski A, Molitch ME, Boyd AE, Sheeler L, Cook DM et al (1992) Octreotide treatment of acromegaly. A randomized, multicenter study. Ann Intern Med 117(9):711–718
Colao A, Ferone D, Marzullo P, Cappabianca P, Cirillo S, Boerlin V, Lancranjan I, Lombardi G (2001) Long-term effects of depot long-acting somatostatin analog octreotide on hormone levels and tumor mass in acromegaly. J Clin Endocrinol Metab 86(6):2779–2786
Freda PU, Katznelson L, van der Lely AJ, Reyes CM, Zhao S, Rabinowitz D (2005) Long-acting somatostatin analog therapy of acromegaly: a meta-analysis. J Clin Endocrinol Metab 90(8):4465–4473. doi:10.1210/jc.2005-0260
Lucas T, Astorga R, Catala M (2003) Preoperative lanreotide treatment for GH-secreting pituitary adenomas: effect on tumour volume and predictive factors of significant tumour shrinkage. Clin Endocrinol (Oxf) 58(4):471–481. doi:10.1046/j.1365-2265.2003.01741.x
Cozzi R, Attanasio R, Montini M, Pagani G, Lasio G, Lodrini S, Barausse M, Albizzi M, Dallabonzana D, Pedroncelli AM (2003) Four-year treatment with octreotide-long-acting repeatable in 110 acromegalic patients: predictive value of short-term results? J Clin Endocrinol Metab 88(7):3090–3098
Colao A, Pivonello R, Auriemma RS, Briganti F, Galdiero M, Tortora F, Caranci F, Cirillo S, Lombardi G (2006) Predictors of tumor shrinkage after primary therapy with somatostatin analogs in acromegaly: a prospective study in 99 patients. J Clin Endocrinol Metab 91(6):2112–2118. doi:10.1210/jc.2005-2110
Resmini E, Dadati P, Ravetti JL, Zona G, Spaziante R, Saveanu A, Jaquet P, Culler MD, Bianchi F, Rebora A, Minuto F, Ferone D (2007) Rapid pituitary tumor shrinkage with dissociation between antiproliferative and antisecretory effects of a long-acting octreotide in an acromegalic patient. J Clin Endocrinol Metab 92(5):1592–1599. doi:10.1210/jc.2006-2084
Casarini AP, Jallad RS, Pinto EM, Soares IC, Nonogaki S, Giannella-Neto D, Musolino NR, Alves VA, Bronstein MD (2009) Acromegaly: correlation between expression of somatostatin receptor subtypes and response to octreotide-lar treatment. Pituitary 12(4):297–303. doi:10.1007/s11102-009-0175-1
Duran-Prado M, Saveanu A, Luque RM, Gahete MD, Gracia-Navarro F, Jaquet P, Dufour H, Malagon MM, Culler MD, Barlier A, Castano JP (2010) A potential inhibitory role for the new truncated variant of somatostatin receptor 5, sst5TMD4, in pituitary adenomas poorly responsive to somatostatin analogs. J Clin Endocrinol Metab 95(5):2497–2502. doi:10.1210/jc.2009-2247
Filopanti M, Ronchi C, Ballare E, Bondioni S, Lania AG, Losa M, Gelmini S, Peri A, Orlando C, Beck-Peccoz P, Spada A (2005) Analysis of somatostatin receptors 2 and 5 polymorphisms in patients with acromegaly. J Clin Endocrinol Metab 90(8):4824–4828. doi:10.1210/jc.2005-0132
Fougner SL, Casar-Borota O, Heck A, Berg JP, Bollerslev J (2012) Adenoma granulation pattern correlates with clinical variables and effect of somatostatin analogue treatment in a large series of patients with acromegaly. Clin Endocrinol (Oxf) 76(1):96–102. doi:10.1111/j.1365-2265.2011.04163.x
Gadelha MR, Kasuki L, Korbonits M (2013) Novel pathway for somatostatin analogs in patients with acromegaly. Trends Endocrinol Metab 24(5):238–246. doi:10.1016/j.tem.2012.11.007
Bhayana S, Booth GL, Asa SL, Kovacs K, Ezzat S (2005) The implication of somatotroph adenoma phenotype to somatostatin analog responsiveness in acromegaly. J Clin Endocrinol Metab 90(11):6290–6295. doi:10.1210/jc.2005-0998
Colao A, Attanasio R, Pivonello R, Cappabianca P, Cavallo LM, Lasio G, Lodrini A, Lombardi G, Cozzi R (2006) Partial surgical removal of growth hormone-secreting pituitary tumors enhances the response to somatostatin analogs in acromegaly. J Clin Endocrinol Metab 91(1):85–92. doi:10.1210/jc.2005-1208
Ezzat S, Kontogeorgos G, Redelmeier DA, Horvath E, Harris AG, Kovacs K (1995) In vivo responsiveness of morphological variants of growth hormone-producing pituitary adenomas to octreotide. Eur J Endocrinol 133(6):686–690
Buchfelder M, Weigel D, Droste M, Mann K, Saller B, Brubach K, Stalla GK, Bidlingmaier M, Strasburger CJ (2009) Pituitary tumor size in acromegaly during pegvisomant treatment: experience from MR re-evaluations of the German Pegvisomant Observational Study. Eur J Endocrinol 161(1):27–35. doi:10.1530/EJE-08-0910
Trainer PJ (2009) ACROSTUDY: the first 5 years. Eur J Endocrinol 161(Suppl 1):S19–S24. doi:10.1530/EJE-09-0322
Jimenez C, Burman P, Abs R, Clemmons DR, Drake WM, Hutson KR, Messig M, Thorner MO, Trainer PJ, Gagel RF (2008) Follow-up of pituitary tumor volume in patients with acromegaly treated with pegvisomant in clinical trials. Eur J Endocrinol 159(5):517–523. doi:10.1530/EJE-08-0205
Marazuela M, Paniagua AE, Gahete MD, Lucas T, Alvarez-Escola C, Manzanares R, Cameselle-Teijeiro J, Luque-Ramirez M, Luque RM, Fernandez-Rodriguez E, Castano JP, Bernabeu I (2010) Somatotroph tumor progression during pegvisomant therapy: a clinical and molecular study. J Clin Endocrinol Metab. doi:10.1210/jc.2010-1742
Bernabeu I, Alvarez-Escola C, Quinteiro C, Lucas T, Puig-Domingo M, Luque-Ramirez M, de Miguel-Novoa P, Fernandez-Rodriguez E, Halperin I, Loidi L, Casanueva FF, Marazuela M (2010) The exon 3-deleted growth hormone receptor is associated with better response to pegvisomant therapy in acromegaly. J Clin Endocrinol Metab 95(1):222–229. doi:10.1210/jc.2009-1630
Bianchi A, Mazziotti G, Tilaro L, Cimino V, Veltri F, Gaetani E, Pecorini G, Pontecorvi A, Giustina A, De Marinis L (2009) Growth hormone receptor polymorphism and the effects of pegvisomant in acromegaly. Pituitary 12(3):196–199. doi:10.1007/s11102-008-0157-8
Jallad RS, Musolino NR, Salgado LR, Bronstein MD (2007) Treatment of acromegaly: is there still a place for radiotherapy? Pituitary 10(1):53–59. doi:10.1007/s11102-007-0002-5
Cozzi R, Barausse M, Asnaghi D, Dallabonzana D, Lodrini S, Attanasio R (2001) Failure of radiotherapy in acromegaly. Eur J Endocrinol 145(6):717–726. doi:10.1530/eje.0.1450717
Castinetti F, Morange I, Dufour H, Regis J, Brue T (2009) Radiotherapy and radiosurgery in acromegaly. Pituitary 12(1):3–10. doi:10.1007/s11102-007-0078-y
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This work was supported by Grant FISS 11/00161 to IB.
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Fernandez-Rodriguez, E., Casanueva, F.F. & Bernabeu, I. Update on prognostic factors in acromegaly: Is a risk score possible?. Pituitary 18, 431–440 (2015). https://doi.org/10.1007/s11102-014-0574-9
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DOI: https://doi.org/10.1007/s11102-014-0574-9