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1Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
2Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
3Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
4Pathology, Yonsei University College of Medicine, Seoul, Korea
Copyright © 2021 Korean Endocrine Society
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICTS OF INTEREST
No potential conflict of interest relevant to this article was reported.
AUTHOR CONTRIBUTIONS
Conception or design: C.R.K., E.J.L. Acquisition, analysis, or interpretation of data: H.J., K.K., D.K., J.H.M., E.H.K., S.H.K., C.R.K. Drafting the work or revising: H.J., C.R.K. Final approval of the manuscript: C.R.K., E.J.L.
Characteristic | Total | GNAS mutation | P value | |
---|---|---|---|---|
| ||||
No mutation | Mutation | |||
No. of patients | 126 | 51 (40.5) | 75 (59.5) | |
| ||||
Age, yr | 42 (35–50) | 43 (36–53) | 41 (34–48) | 0.098 |
| ||||
Sex | 0.006 | |||
Male | 51 (40.5) | 12 (23.5) | 39 (52.0) | |
Female | 75 (59.5) | 39 (76.5) | 36 (48.0) | |
| ||||
Follow-up duration, mo | 75.5 (63.3–97.4) | 73.4 (52.5–95.9) | 86.0 (69.8–99.8) | 0.051 |
| ||||
Size, mm | 15 (10.75–20.0) | 15 (12–23) | 14 (10–18) | 0.052 |
| ||||
Knosp classification | 0.100 | |||
0 | 18 (14.3) | 5 (9.8) | 13 (17.3) | |
1 | 48 (38.1) | 21 (41.2) | 27 (36.0) | |
2 | 41 (32.5) | 13 (25.5) | 28 (37.3) | |
3a | 12 (9.5) | 6 (11.8) | 6 (8.0) | |
3b | 1 (0.8) | 1 (2.0) | 0 | |
4 | 6 (4.8) | 5 (9.8) | 1 (1.3) | |
| ||||
Immunohistochemical staining | 0.015 | |||
Focal GH | 1 (0.8) | 1 (2.1) | 0 | |
Weak GH | 5 (4.0) | 3 (5.9) | 2 (2.6) | |
GH | 120 (95.2) | 47 (92.2) | 73 (97.3) | |
| ||||
Ki-67 staining, % | 97 | 41 | 56 | 0.604 |
<1 | 44 | 20 | 24 | |
1–2 | 38 | 14 | 24 | |
2–3 | 13 | 7 | 6 | |
>3 | 2 | 0 | 2 |
Variable | Total | GNAS mutation | P value | |
---|---|---|---|---|
| ||||
No mutation | Mutation | |||
TSA, total/subtotal | 115 (91.3)/11 (8.7) | 43 (84.3)/8 (15.7) | 72 (96.0)/3 (4.0) | 0.075 |
| ||||
Preoperative OGTT | ||||
Basal GH, ng/mL | 15.1 (6.9–32.3) | 16.1 (5.9–32.2) | 14.7 (7.5–32.4) | 0.785 |
Nadir GH, ng/mL | 11.0 (5.1–23.8) | 8.7 (4.6–23.3) | 11.4 (6.0–24.3) | 0.380 |
IGF-1, ng/mL | 753.1 (600.0–899.2) | 697.0 (561.2–884.4) | 770.9 (647.0–903.5) | 0.045 |
| ||||
Immediate postoperative OGTT | ||||
Basal GH, ng/mL | 0.9 (0.5–1.8) | 1.0 (0.6–2.6) | 0.9 (0.4–1.7) | 0.191 |
Nadir GH, ng/mL | 0.4 (0.1–0.9) | 0.6 (0.2–1.5) | 0.3 (0.1–0.7) | 0.012 |
IGF-1, ng/mL | 342.1 (280.9–467.6) | 336.0 (256.4–494.9) | 348.3 (292.9–435.8) | 0.393 |
Remission | 81 (64.3) | 28 (54.9) | 53 (70.7) | 0.011 |
| ||||
Postoperative OGTT at 6 mo | ||||
Basal GH, ng/mL | 0.13 (0.1–0.3) | 1.1 (0.4–2.6) | 0.7 (0.1–2.1) | 0.125 |
Nadir GH, ng/mL | 0.9 (0.2–2.5) | 0.15 (0.1–0.3) | 0.12 (0.1–0.3) | 0.305 |
IGF-1, ng/mL | 250.3 (205.3–322.9) | 243.3 (202.0–318.7) | 254.8 (211.3–324.8) | 0.767 |
Remission | 106 (84.1) | 42 (82.4) | 64 (85.3) | 0.007 |
Variable | GNAS mutation | P value | |
---|---|---|---|
| |||
No mutation | Mutation | ||
Postoperative growth hormone levels | |||
0 hr | 2.00 (1.20–5.04) | 2.70 (1.00–8.50) | 0.648 |
12 hr | 0.95 (0.45–1.78) | 0.70 (0.40–1.33) | 0.131 |
24 hr | 1.10 (0.48–1.94) | 0.68 (0.42–1.27) | 0.047 |
48 hr | 1.08 (0.52–1.89) | 0.70 (0.38–1.20) | 0.043 |
72 hr | 0.99 (0.53–1.90) | 0.74 (0.33–1.22) | 0.011 |
No. | Age, yr/ Sex | GNAS mutation | Tumor size, mm | Knosp classification | Initial GH, ng/mL | Initial IGF-1, ng/mL | Last GH, ng/mL | Last IGF-1, ng/mL | Remnant tumor on MRI | Treatment |
---|---|---|---|---|---|---|---|---|---|---|
1 | 44/F | Yes | 20 | 2 | 35.85 | 1,015.7 | 0.46 | 229.4 | No | Cabergoline 2 mg/wk |
2 | 39/M | Yes | 12 | 3a | 24.5 | 1,423 | 0.5 | 323 | No | Cabergoline 2 mg/wk |
3 | 36/F | Yes | 19 | 0 | 23.6 | 852.8 | 0.99 | 296.8 | No | Cabergoline 2 mg/wk |
4 | 50/F | No | 12 | 1 | 18.3 | 398.5 | 1 | 297 | No | Octreotide LAR 20 mg every 4 wk |
5 | 36/F | No | 30 | 4 | 19.29 | 884.4 | 0.96 | 263.8 | Yes | GKS→cabergoline 2 mg/wk |
6 | 39/M | No | 35 | 4 | 70.8 | 774.1 | 1.7 | 365.1 | Yes | GKS→octreotide LAR 20 mg every 4 wk |
7 | 58/F | No | 20 | 4 | 5.9 | 555.6 | 0.77 | 193.2 | Yes | GKS→lanreotide autogel 60 mg every 4 wk |
8 | 29/F | No | 30 | 2 | 27.63 | 1,036.8 | 2.1 | 273.9 | Yes | Reoperation, GKS→octreotide LAR 30 mg every 4 wk |
Factor | OR (95% CI) | P value |
---|---|---|
Age, /1 year increment | 0.984 (0.897–1.079) | 0.731 |
| ||
Sex | ||
Male | Reference | |
Female | 1.577 (0.262–9.481) | 0.619 |
| ||
Preoperative random GH, /1 ng/mL increment | 0.913 (0.784–1.064) | 0.243 |
| ||
Preoperative OGTT nadir GH, /1 ng/mL increment | 1.110 (0.941–1.309) | 0.214 |
| ||
Preoperative IGF-1, /1 ng/mL increment | 1.004 (1.000–1.008) | 0.034 |
| ||
Knosp classification | ||
Grade 0–2 | Reference | |
Grade 3–4 | 1.004 (0.118–8.567) | 0.997 |
| ||
Cavernous sinus invasion | ||
No invasion | Reference | |
Invasion | 6.202 (1.192–32.262) | 0.030 |
| ||
GNAS mutation | ||
No mutation | Reference | |
Mutation | 0.192 (0.035–1.058) | 0.058 |
Values are expressed as number (%) or median (interquartile range).
Values are expressed as number (%) or median (interquartile range).
Values are expressed as median (interquartile range).
OR, odds ratio; CI, confidence interval; GH, growth hormone; OGTT, oral glucose tolerance test; IGF-1, insulin-like growth factor-1;