Giant GH-secreting pituitary adenomas: management of rare and aggressive XXXX .

@entity1 @entity227 @entity9229 @entity442 @entity22798 @entity2012 @entity977 @entity1943 @entity652
OBJECTIVES: @entity1 with @entity2012 usually harbor macroadenomas measuring between 10 and 30mm in maximal diameter. Giant ( @entity652 size >= 40mm) GH-secreting @entity977 are rarely encountered and the aim of this study is to analyze different methods for managing them. DESIGN AND METHODS: We have identified 34 @entity1 (15 @entity1 and 19 females) with @entity652 among 762 subjects (4.5%) with @entity2012 in our records, and characterized their clinical characteristics and response to treatment. RESULTS: Mean age at diagnosis was 34.9  12.5 years (range, 16-67 years). Mean @entity652 size was 49.4  9.4mm (range, 40-80mm); 30 @entity652 showed cavernous sinus invasion and 32 had suprasellar extension. Twenty-nine (85%) @entity1 had @entity227 . Mean baseline @entity442 was 3.4  1.8*ULN. All @entity1 except one underwent pituitary surgery (one to three procedures), but none achieved hormonal remission following first surgery. Among the 28 subjects with @entity227 , 14 recovered post-operatively and 13 improved. Treatment with @entity1943 analogs was given to all @entity1 after surgical failure. Six achieved remission, nine others were partially controlled ( @entity442 <1.5*ULN; 3/9 when combined with @entity9229 ), and 17 did not respond (two were lost). Nine @entity1 were treated with pegvisomant, alone (n=4) or in combination with @entity1943 analogs (n=5); five are in remission and two are partially controlled. @entity22798 -LAR achieved hormonal remission in one of the six @entity1 . Currently, after a mean follow-up period of 8.9 years, 17 @entity1 are in biochemical remission, eight are partially controlled, and seven are uncontrolled (two were lost to follow-up). CONCLUSIONS: Giant GH-secreting @entity652 are invasive, uncontrolled by surgery, and respond poorly to medical treatment. Aggressive multimodal therapy is critical for their management, enhancing control rate and biochemical remission.
