title: Case report: acromegaly and Cushing's disease in a patient with synchronous pituitary adenomas.
abstract: A 40-year-old white woman presented with hirsutism, amenorrhea, generalized fatigue, diffuse weight gain, acral changes, and coarsened facial features. Physical examination revealed mild diastolic hypertension, acromegalic features, hirsutism, and seborrhea. The growth hormone concentration was elevated and did not suppress after glucose administration. Urinary free cortisol excretion was increased and was not suppressed during a 2 mg low-dose dexamethasone suppression test. Magnetic resonance imaging of the sella demonstrated a 1.3 x 1.2 x 0.8 cm pituitary adenoma. Trans-sphenoidal resection was performed, and portions of the resected tumor were analyzed by routine pathologic methods. Histopathologic and immunohistochemical findings indicated discrete growth hormone- and adrenocorticotropic hormone-producing pituitary adenomas. Coexisting acromegaly and Cushing's syndrome due to pituitary neoplasia was previously reported in two patients. However, to the authors' knowledge, this represents the first description of a patient with acromegaly and Cushing's disease resulting from discrete synchronous adenomas of the pituitary gland as defined by modern histopathologic techniques.
authors.affiliation: Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: L S
authors.initials: LS
authors.lastname: Blevins
authors.forename: G S
authors.initials: GS
authors.lastname: Hall
authors.forename: D H
authors.initials: DH
authors.lastname: Madoff
authors.forename: E R
authors.initials: ER
authors.lastname: Laws
authors.forename: G S
authors.initials: GS
authors.lastname: Wand
mesh_terms: D015068:17-Ketosteroids / Q000652:urine; D000172:Acromegaly / Q000097:blood / Q000209:etiology* / Q000652:urine; D000236:Adenoma / Q000097:blood / Q000175:diagnosis* / Q000601:surgery / Q000652:urine; D000328:Adult; D003480:Cushing Syndrome / Q000097:blood / Q000209:etiology* / Q000652:urine; D003687:Dehydroepiandrosterone / Q000031:analogs & derivatives / Q000097:blood; D019314:Dehydroepiandrosterone Sulfate; D003907:Dexamethasone; D005260:Female; D006628:Hirsutism / Q000097:blood / Q000209:etiology / Q000652:urine; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D008279:Magnetic Resonance Imaging; D010911:Pituitary Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery / Q000652:urine; D012016:Reference Values; D013739:Testosterone / Q000097:blood
chemical_list: D015068:17-Ketosteroids; D013739:Testosterone; D003687:Dehydroepiandrosterone; D019314:Dehydroepiandrosterone Sulfate; D003907:Dexamethasone; D006854:Hydrocortisone