title: Pituitary adenocarcinoma in an acromegalic patient: response to bromocriptine and pituitary testing: a review of the literature on 36 cases of pituitary carcinoma.
abstract: There are 36 reported cases of metastatic pituitary carcinoma and almost half (44%) of these were associated with syndromes of hormonal hypersecretion. The case of a 56-year-old acromegalic man with cervical lymphatic and spinal metastases from a primary pituitary carcinoma is described. Elevated basal levels of plasma growth hormone (GH) and insulin growth factor-1/Somatomedin C (IGF-1/SmC) were found. GH levels did not increase after TRH or LHRH administration but decreased after L-Dopa and glucose. Immunostaining of the metastatic tumor for GH and electron microscopy findings confirmed the diagnosis of pituitary GH-secreting carcinoma. Striking clinical improvement and a 46% decrease in plasma GH levels were observed with bromocriptine treatment, although IGF-1/SmC levels increased during therapy. The clinical course of most reported cases of pituitary adenocarcinoma has been one of progressive intracranial expansion of a pituitary neoplasm. In only 25% were metastatic lesions discovered antemortem, and disabling symptomatology caused by metastases was rare. Only four previously reported patients of 36 with pituitary carcinoma had acromegaly.
authors.affiliation: Veterans Administration Medical Center, Charleston, South Carolina.
authors.forename: R B
authors.initials: RB
authors.lastname: Mountcastle
authors.forename: B S
authors.initials: BS
authors.lastname: Roof
authors.forename: R K
authors.initials: RK
authors.lastname: Mayfield
authors.forename: D B
authors.initials: DB
authors.lastname: Mordes
authors.forename: J
authors.initials: J
authors.lastname: Sagel
authors.forename: P J
authors.initials: PJ
authors.lastname: Biggs
authors.forename: S E
authors.initials: SE
authors.lastname: Rawe
mesh_terms: D000172:Acromegaly / Q000097:blood / Q000150:complications*; D000230:Adenocarcinoma / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D000818:Animals; D001971:Bromocriptine / Q000627:therapeutic use*; D006224:Cricetinae; D013006:Growth Hormone / Q000097:blood; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000097:blood; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000097:blood / Q000150:complications* / Q000188:drug therapy
chemical_list: D001971:Bromocriptine; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone