Co-secreting pituitary adenomas in acromegaly: Classification, diagnosis, and treatment strategies

Co-secreting pituitary adenomas (PAs) represent a subset of pituitary tumors with distinct clinical and pathological characteristics. These tumors can secrete both growth hormone (GH) and prolactin (PRL), impacting the clinical presentation, treatment response, and long-term outcomes of acromegaly. This chapter reviews the classification, pathophysiology, and clinical implications of GH and PRL co-secreting PAs, integrating data from previously published studies. Additionally, we discuss treatment strategies, including surgical and medical approaches, highlighting the impact of the treatment with cabergoline and somatostatin receptor ligands (SRLs) in biochemical control. The predictors of surgical and medical treatment resistance, including Knosp grade, tumor size, and baseline hormone levels, are also addressed. Understanding the unique behavior of these tumors is crucial for optimizing treatment strategies and improving patient outcomes.