Growth Hormone and Prolactin Staining Tumors Causing Acromegaly: A Retrospective Review of Clinical Presentations and Surgical Outcomes Jonathan William Rick; Arman Jahangiri BS; Patrick Michael Flanigan BS; Ankush Chandra MS; Sandeep Kunwar MD, FACS; Lewis Blevins MD; Manish Kumar Aghi MD, PhD

Introduction Results Conclusions Up to a quarter of acromegalics will present Of 593 pituitary adenoma patients, 91 Acromegalics with tumors that stain for with tumors that also stain for prolactin. presented with acromegaly. Of these 91 prolactin and GH, which represented almost These patients may have different patients, 69 (76%) had tumors that stained a quarter of acromegalics in our cohort, had treatment outcomes. for GH only (single-staining somatrophic more aggressive clinical presentations and pituitary adenomas, SSPAs), while 22 postoperative outcomes than single staining (24%) had tumors that stained for GH and tumors. Prolactin staining provides useful Methods prolactin (DSPAs). Patients with DSPAs information for acromegalics undergoing We retrospectively reviewed over five years were more likely to present with decreased pituitary surgery. of pituitary adenomas resected at our libido (p=0.012), acromegalic growth institution. (p=0.0001), hyperhidrosis (p=0.0001), and headaches (p=0.043) than patients Learning Objectives with SSPAs. DSPAs presented with 1) Appreciate that dual staining pituitary significantly higher serum prolactin (60.7 adenomas are common and often have µg/L vs. 10.0 µg/L ; p=0.0002) and GH different outcomes, 2) recognize that (803.6 ng/ml vs. 480.0 ng/ml; P=0.0001) pathological analysis may provide clues into and were more likely to have IGF-1 levels the cellular origins of tumors. >650 ng/ml (13, 81.3% vs. 6, 21.4% ; P= 0.0001) than patients with SSPAs despite similar sizes (1.7 cm vs. 1.8 cm ; P=0.5). Patients with DSPAs under 35 years of age [Default Poster] were more likely to have a recurrence (4, 50.0% vs. 3, 11.1%; p= 0.01) than patients with SSPAs under the age of 35. DSPAs were less likely to achieve remission with surgery than SSPA patients (2, 20% vs. 19, 67%; p=0.01). Univariate analysis identified single staining tumors (p=0.02), gross total resection (p=0.02) and tumor diameter (p=0.05) as predictors of surgical remission. Multiple logistic regression identified that single staining tumors (p=0.04) were independently associated with surgical remission of acromegaly. Kaplan-Meier analysis revealed that DSPAs had more time until disease remission (P=0.033).