J Korean Soc Endocrinol.  2006 Feb;21(1):53-57. 10.3803/jkes.2006.21.1.53.

A Case of Acromegaly Caused by Double Pituitary Adenomas

Affiliations
  • 1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
  • 2Department of pathology, Yonsei University College of Medicine, Seoul, Korea.

Abstract

Acromegaly is a clinical syndrome, which is caused by an excess of growth hormone (GH), most commonly secreted from a pituitary solitary adenoma. However, our patient had bilateral GH-secreting pituitary tumors, the incidence of which has been reported in only 1.3 to 1.69% of all acromegalic patients. A 59-year-old female, with no family history of pituitary adenomas, demonstrated an increased level of serum insulin-like growth factor-1 (IGF-1), and GH not suppressed after 75 g oral glucose loading. On a preoperative MRI, only one pituitary tumor, measuring 1.1 x 0.7 cm, could be observed using sellar MRI. After surgical resection of the tumor, her headache and myalgia were sustained, and the IGF-1 level was still in a high titer. Therefore, a follow-up sellar MRI was taken, and a 0.6 x 0.7 cm sized newly growing pituitary tumor was found on the other side. With a retrospective review of radiological examinations, the patient was found to have bilateral tumors. The 0.3 cm sized tumor on the left was too small to be detected on the preoperative MRI. As the patient preferred medical treatment after surgery, she was treated with sandostatin analogues. Acromegaly with bilateral GH-secreting pituitary tumors, is a very rare disease, with no previous case having been reported in Korea. Herein, we report the case with a review of the literature.


MeSH Terms

Acromegaly*
Adenoma
Female
Follow-Up Studies
Glucose
Growth Hormone
Headache
Humans
Incidence
Insulin-Like Growth Factor I
Korea
Magnetic Resonance Imaging
Middle Aged
Myalgia
Octreotide
Pituitary Neoplasms*
Rare Diseases
Retrospective Studies
Glucose
Growth Hormone
Insulin-Like Growth Factor I
Octreotide

Figure

  • Fig. 1 Two separate pituitary tumors on Sellar Magnetic resonance image (MRI), coronal view. (A) Preoperative sellar MRI shows 1.1 × 0.7 cm sized pituitary adenoma on right sellar wing (arrowhead), and 0.3 cm sized another pituitary adenoma on the left (arrow). (B) Postoperative sellar MRI shows 0.7 × 0.6 cm sized growing state another tumor previously existed (arrow) as shown above.

  • Fig. 2 Histologic findings of the surgical specimen of pituitary adenoma. (A) The fragmented gray white tumor showed solid and cellular lesion with highly vascular structures (H & E stain, × 40). (B) The tumor cells are monotonous and arranged around capillaries forming rossetoid structure (H & E stain, × 400).

  • Fig. 3 Immunohistochemical staining of surgical specimen of pituitary adenoma. (A) Tumor cells show strong and diffuse immunoreactivity to GH (× 400), (B) focal but strong immunoreactivity to prolactin (× 400), (C) but no immunoreactivity to ACTH (× 400).

  • Fig. 4 Flow chart of IGF-1 level. Serial change of IGF-1 level before and after surgery.


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