title: Elevated inferior petrosal sinus levels of PTHrP in a patient with Cushing's disease.
abstract: PTHrP has been found in various tissues, including prolactinomas and growth hormone producing adenomas. The function and clinical importance of PTHrP are poorly understood. We report the case of a 25-year-old female patient with hirsutism. Autonomous ACTH-dependent hypercortisolism was documented by endocrine testing. Magnetic resonance imaging (MRI) revealed a 3-mm intrasellar hypointense lesion in the left side of the pituitary gland. The inferior petrosal sinus sampling disclosed a gradient of ACTH left central/peripheral of 30.5 and right central/peripheral of 2.0 and suggested the diagnosis of a left-sided pituitary ACTH secreting microadenoma. Interestingly, we found elevated PTHrP levels in the left inferior petrosal sinus with a gradient of 4.7 compared to peripheral venous blood and of 3.6 compared to the right sinus. Our results fit very well to the concept of a para-/autocrine secretion of PTHrP which has been proposed recently and suggest a role in the regulation of cell growth of pituitary adenomas.
authors.affiliation: Department of Internal Medicine, Landeskrankenhaus Feldkirch, Austria. guenter.hoefle@vol.at
authors.forename: G
authors.initials: G
authors.lastname: Höfle
authors.forename: R W
authors.initials: RW
authors.lastname: Gasser
authors.forename: M
authors.initials: M
authors.lastname: Buchfelder
authors.forename: R
authors.initials: R
authors.lastname: Fahlbusch
authors.forename: P
authors.initials: P
authors.lastname: Waldenberger
authors.forename: G
authors.initials: G
authors.lastname: Finkenstedt
mesh_terms: D000236:Adenoma / Q000097:blood* / Q000150:complications; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D003480:Cushing Syndrome / Q000097:blood* / Q000209:etiology; D005260:Female; D006801:Humans; D044162:Parathyroid Hormone-Related Protein; D017591:Petrosal Sinus Sampling; D010911:Pituitary Neoplasms / Q000097:blood* / Q000150:complications; D011506:Proteins / Q000032:analysis*
chemical_list: C470121:PTHLH protein, human; D044162:Parathyroid Hormone-Related Protein; D011506:Proteins; D000324:Adrenocorticotropic Hormone