A Case of Pituitary Adenoma Producing both Growth Hormone(GH) and Adrenocorticotropic Hormone(ACTH).

Abstract

The authors report a very rare case of pituitary adenoma producing both GH and ACTH. A 29-year-old female was admitted with obesity, amenorrhea, acromegaly, hirsutism, excessive pigmentation, acne, and diabetes mellitus. Computed tomography revealed an intrasellar tumor 16 mm in height, with a destroyed sellar floor. The blood concentrations of GH, ACTH and cortisol were increased (GH: 92 ng/ml, ACTH: 94 pg/ml, cortisol: 18.3 micrograms/dl). No diurnal variation in the amount of cortisol was observed. The urinary 17-OHCS was suppressed by 8 mg but not by 2 mg of dexamethasone. A subtotal adenomectomy was then performed through the transsphenoidal approach, which led to a sufficient reduction of both blood GH and ACTH (cortisol). Histologically the tumor was an acidophilic pituitary adenoma. Immunoperoxidase staining showed diffuse GH and sporadic ACTH producing cells, but failed to show any cells producing both hormones. The electron micrograms of neoplastic cells showed the ultrastructural characteristics of respective GH and ACTH cells. Another increase in both GH and cortisol, which occurred 19 months after the operation, has been controlled by bromocriptine administration. This case may be the first reported case of a pituitary adenoma producing both GH and ACTH, not accompanied by prolactin (PRL) hypersecretion, which has been fully confirmed endocrinologically and histopathologically.

Corticotroph Cell Adenoma without Typical Manifestations of Cushing's Disease Presenting with Cavernous Sinus Syndrome following Pituitary Apoplexy.

“…This hormone combination of ACTH and GH, produced by a single adenoma with hormone-secreting symptoms, has also been previously reported [9][10][11]. However, to our knowledge, a silent corticotroph adenoma with GH production, such as in our case, has never been reported.…”

“…Cavernous sinus syndrome, in which a pituitary adenoma extends laterally into the cavernous intracranial sinus, is an uncommon complication of pituitary apoplexy [8]. In addition, a pituitary adenoma producing both ACTH and GH is highly unusual [9][10][11]. We report a unique case of a 30-yearold man with corticotroph cell adenoma, without acromegaly or other features typical of Cushing's disease, who presented with cavernous sinus syndrome following pituitary apoplexy.…”

A somatotropin-producing pituitary adenoma with an isolated adrenocorticotropin-producing pituitary adenoma in a female patient with acromegaly, subclinical Cushing’s disease and a left adrenal tumor

“…Although several combinations of hormonally-functioning double pituitary adenomas have been reported [4][5][6][7][15][16][17][18][19][20][21][22][23][24][25][26][27][28], the coexistence of acromegaly and pituitary Cushing's disease is rare [3,[8][9][10][11] (Table 4). Although our case resembles previous cases in terms of the immunohistochemical staining pattern, ours differs in the lack of Cushingoid features (i.e.…”

A Case of Acromegaly Associated with Subclinical Cushing's Disease

“…GH-producing pituitary adenomas are often accompanied with multi-hormonal production, such as PRL and TSH [7]. However, pituitary adenoma producing both GH and ACTH is extremely rare; only 4 cases have been reported thus far [3][4][5][6]. Thus, the present GH-producing adenoma with concomitant ACTH production adds the fifth case to the literature.…”

“…However, only a few cases of ACTH-producing pituitary adenoma without overt Cushingoid features (subclinical/ preclinical Cushing's disease) have been reported thus far [2]. Furthermore, only 4 cases of pituitary adenoma with concomitant production of both ACTH and GH causing Cushing's disease and acromegaly, respectively, have been reported [3][4][5][6].…”