Two familial giant pituitary adenomas associated with overweight: clinical, morphological and genetic features.
OBJECTIVE
Pituitary adenomas are usually sporadic, although rare familial cases have been described. Here we report two first degree female cousins with giant pituitary adenoma and overweight. Both presented with secondary amenorrhoea, occasional headache and weight gain.


METHODS
In both patients clinical, morphological and genetic studies were performed. Both patients underwent surgery and post-operative medical therapy with somatostatin analogues and dopamine agonist, followed by a conventional radiotherapy course.


RESULTS
Clinical examination at presentation revealed an acromegaloid habitus only in the second patient. Basal and dynamic hormonal evaluation showed high serum GH and serum IGF-I values, higher in the second than in the first patient, and a mild hyperprolactinaemia only in the first patient. On optical and electron microscopy, both tumours were oncocytic adenomas, immunopositive for GH in the first patient and GH/prolactin in the second. The genetic analysis for germ-line mutations of the multiple endocrine neoplasia type 1 gene was negative. Two years after radiotherapy a remarkable shrinkage of both tumours was observed, whereas the overweight worsened in both patients, accompanied by high plasma leptin values.


CONCLUSIONS
To our knowledge, this is the first report of familial pituitary adenomas including one case of a clinically silent GH-secreting adenoma. In addition, it provides further evidence that familial pituitary tumours can occur as a multiple endocrine neoplasia type 1 unrelated disease.
Department of Experimental Medicine, University of L'Aquila, Italy. eliferretti@tin.it
E
E
Ferretti
M L
ML
Jaffrain Rea
C
C
Asteria
D
D
Di Stefano
V
V
Esposito
L
L
Ferrante
P
P
Daniele
C
C
Tiberti
M
M
Gallucci
C
C
Bosman
E
E
Alesse
A
A
Gulino
P
P
Beck-Peccoz
G
G
Tamburrano
D000236:Adenoma / Q000097:blood / Q000235:genetics* / Q000473:pathology* / Q000628:therapy; D000328:Adult; D000568:Amenorrhea / Q000150:complications; D000886:Anthropometry; D004252:DNA Mutational Analysis; D005192:Family Health; D005260:Female; D005820:Genetic Testing; D006261:Headache / Q000150:complications; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D020738:Leptin / Q000097:blood; D008279:Magnetic Resonance Imaging; D008854:Microscopy, Electron; D018761:Multiple Endocrine Neoplasia Type 1 / Q000235:genetics; D009154:Mutation / Q000235:genetics; D010911:Pituitary Neoplasms / Q000097:blood / Q000235:genetics* / Q000473:pathology* / Q000628:therapy; D011388:Prolactin / Q000097:blood; D015430:Weight Gain / Q000235:genetics*
D020738:Leptin; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D011388:Prolactin