Cushing's disease due to plurihormonal adrenocorticotropic hormone and gonadotropin-producing pituitary adenoma.
A 67-year-old woman presented with clinical features of hypercortisolism in association with an invasive pituitary macroadenoma. Adrenocorticotropic hormone (ACTH)-dependent Cushing's disease was documented, and the resected tumor was chromophobic, weakly positive with periodic-Schiff reagent, and showed immunostaining for ACTH and beta-endorphin in a minority of adenoma cells. Both luteinizing hormone and alpha-subunit staining were also observed, but no follicle-stimulating hormone reactivity was seen. Ultrastructurally, the tumor showed typical features of a gonadotroph adenoma of female type. Immunoelectron microscopy showed that ACTH was not produced in corticotrophs, but in cells with the characteristic features of gonadotrophs. This represents the second report of a plurihormonal gonadotroph adenoma producing sufficient ACTH to result in pituitary-dependent Cushing's disease.
Egensperger
R
R
Department of Pathology, Mayo Clinic, Rochester, MN 55905, USA.
Scheithauer
B W
BW
Horvath
E
E
Kovacs
K
K
Giannini
C
C
Young
W F
WF
Lloyd
R
R
Atkinson
J
J
Nippoldt
T B
TB
D000236:Adenoma / Q000737:chemistry / Q000150:complications* / Q000473:pathology; D000324:Adrenocorticotropic Hormone / Q000032:analysis*; D000368:Aged; D003480:Cushing Syndrome / Q000209:etiology*; D005260:Female; D006062:Gonadotropins / Q000032:analysis*; D006801:Humans; D007986:Luteinizing Hormone / Q000032:analysis; D008279:Magnetic Resonance Imaging; D016253:Microscopy, Immunoelectron; D010911:Pituitary Neoplasms / Q000737:chemistry / Q000150:complications* / Q000473:pathology
D006062:Gonadotropins; D000324:Adrenocorticotropic Hormone; D007986:Luteinizing Hormone