title: Cushing's disease due to plurihormonal adrenocorticotropic hormone and gonadotropin-producing pituitary adenoma.
abstract: 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.
authors.affiliation: Department of Pathology, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: R
authors.initials: R
authors.lastname: Egensperger
authors.forename: B W
authors.initials: BW
authors.lastname: Scheithauer
authors.forename: E
authors.initials: E
authors.lastname: Horvath
authors.forename: K
authors.initials: K
authors.lastname: Kovacs
authors.forename: C
authors.initials: C
authors.lastname: Giannini
authors.forename: W F
authors.initials: WF
authors.lastname: Young
authors.forename: R
authors.initials: R
authors.lastname: Lloyd
authors.forename: J
authors.initials: J
authors.lastname: Atkinson
authors.forename: T B
authors.initials: TB
authors.lastname: Nippoldt
mesh_terms: 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
chemical_list: D006062:Gonadotropins; D000324:Adrenocorticotropic Hormone; D007986:Luteinizing Hormone