From macroprolactinoma to concomitant ACTH-PRL hypersecretion with Cushing's disease.
Multiple pituitary hormone hypersecretions have been already described, but the combination of PRL and ACTH excess is rare. This report deals with a 42-yr-old woman affected by macroprolactinoma (PRL 12,720 microg/l, huge tumor with extrasellar extension at imaging). After one year on dopaminergic treatment causing PRL normalization and tumor shrinkage, she developed hypercortisolism (UFC 1,000 microg/24 h, ACTH 200 ng/l). Cushing's disease was diagnosed. After neurosurgery (at immunocytochemistry mixed ACTH-PRL adenoma was shown) hypercortisolism remitted, whereas pathological hyperprolactinemia with tumor remnant in cavernous sinus persisted and hypopituitarism developed. The patient reported seems atypical for the following reasons: 1) the concomitant PRL and ACTH hypersecretions; 2) the clinical presentation with hypercortisolism following hyperprolactinemia; 3) the surgical cure of hypercortisolism with persisting hyperprolactinemia.
Barausse
M
M
Department of Endocrinology, Niguarda Hospital, Milano, Italy.
Attanasio
R
R
Dallabonzana
D
D
Oppizzi
G
G
Veronese
S
S
Lasio
G
G
Valentini
L G
LG
Cozzi
R
R
D000324:Adrenocorticotropic Hormone / Q000097:blood / Q000378:metabolism*; D000328:Adult; D003480:Cushing Syndrome / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000601:surgery; D003919:Diabetes Insipidus / Q000209:etiology; D005260:Female; D006801:Humans; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000601:surgery; D011183:Postoperative Complications; D011388:Prolactin / Q000097:blood / Q000378:metabolism*; D015175:Prolactinoma / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000601:surgery; D011859:Radiography
D000324:Adrenocorticotropic Hormone; D011388:Prolactin