Plurihormonal pituitary macroadenoma:  a case report

Abstract

Background Plurihormonal pituitary adenomas are a unique type of pituitary adenomas that secrete two or more pituitary hormones normally associated with separate cell types that have different immunocytochemical and ultrastructural features. Although they represent 10–15% of all pituitary tumors, only a small fraction of plurihormonal pituitary adenomas clinically secrete multiple hormones. The most common hormone combinations secreted by plurihormonal pituitary adenomas are growth hormone, prolactin, and one or more glycoprotein hormones. The most common hormonal symptom is acromegaly (50%). The aim of this case report is to bring awareness about this rare type of pituitary adenomas and to describe the unique presentation of our patient, even though plurihormonal pituitary adenomas are known mostly as a clinically silent tumors. Case presentation Herein, we describe an unusual case of plurihormonal pituitary adenoma with triple-positive staining for adrenocorticotropic hormone, growth hormone, and prolactin. The patient is a 65-year-old Egyptian woman who presented with mass effect symptoms of the pituitary tumor, which primarily manifested as severe headache and visual field defects. She also presented with some cushingoid features, and further analysis confirmed Cushing’s disease; slightly high prolactin and normal growth hormone levels were observed. She underwent transsphenoidal surgery and has been in remission thus far. Only a few cases have been reported in the literature, but none has exhibited silent acromegaly or mass effect symptoms as the initial presentation. Conclusion This case highlights an unusual plurihormonal pituitary adenoma case with a rare combination of secreted hormones; mass effect symptoms were dominant, as were uncommon visual field defects. Our case further proves that immunohistochemical analyses of all pituitary hormones are needed to ensure correct diagnosis and to alert clinicians to the need for more rigorous follow-up due to the higher morbidity of these patients. Our case report approval number Federal Wide Assurance NIH, USA is FWA00018774 IRB registration number with OHRP/NIH is IRB00010471.

Plurihormonal pituitary adenoma cosecreting ACTH and GH: a rare cause of Cushing’s disease

“…Most common associated hormones are GH and PRL. This is believed to be related to somatotroph and lactotroph cells originating from the same cell progenitor, and sharing the same regulating transcription factor PIT-1 2. Cosecretion of GH and ACTH is considered rare with only 25 cases identified in literature.…”

“…The most common association is with growth hormone (GH) and prolactin (PRL) 1. So far in the literature, only 25 cases reported cosecretion of GH and adrenocorticotrophic hormone (ACTH) 1–5. The predominant presentation was related to GH excess, and only four presented with Cushing’s disease (CD).…”

Decision-Making and Management in a Patient With Coexistent Colloid Cyst and Pituitary Macroadenoma: A Case Report

“…The prevalence of these tumors is approximately 1 case per 1,000 in the general population [ 4 , 12 ]. Functional pituitary adenomas most commonly secrete growth hormone, prolactin, or thyroid-stimulating hormone, although they rarely may secrete adrenocorticotropic hormone (ACTH) [ 13 , 14 ]. Pituitary adenomas may also secrete multiple hormones simultaneously, possibly resulting from neoplastic transformation of different cell lines or trans-differentiation of one cell line into a different hormone-producing one.…”

Plurihormonal Pituitary Neuroendocrine Tumors: Clinical Relevance of Immunohistochemical Analysis

“…Plurihormonal PitNETs express two or more types of pituitary hormones. To date, we do not have a clear etiology for these tumors, but their pathogenesis is hypothesized to be a result of the neoplastic transformation of two different cell lines or the trans-differentiation of a once-tumor cell line into a different hormone-producing cell line [1].…”