A multihormonal pituitary adenoma with growth hormone and adrenocorticotropic hormone production, causing acromegaly and Cushing disease.
Pituitary adenoma with growth hormone (GH) and corticotropin (ACTH) production causing apparent acromegaly and Cushing disease is extremely rare. A 45-year-old woman had a pituitary macroadenoma and severe insulin resistance. Physical examination showed a fully developed acromegaly associated with mild Cushingoid features. Serum GH, insulin-like growth factor-I, ACTH, and cortisol levels were all elevated. Hormonal loading tests resulted in GH levels increasing paradoxically in response to thyrotropin-releasing hormone (TRH), but not corticotropin-releasing hormone (CRH). A similar unexpected increase in ACTH and cortisol levels occurred in response to TRH and GH-releasing hormone. After trans-sphenoidal resection of the pituitary macroadenoma immunohistochemistry revealed the presence of either diffuse but faintly GH-positive cells or sparse but distinct ACTH-stained cells. A marked amelioration of insulin resistance was observed postoperatively. The elevated ACTH and cortisol levels should therefore be investigated by CRH and dexamethasone suppression tests for the coexistence of Cushing disease to exclude the possibility of underlying ACTH-producing tumors.
Kageyama
Kazunori
K
Third Department of Internal Medicine, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan kkageyama@hkg.odn.ne.jp
Nigawara
Takeshi
T
Kamata
Yoshimasa
Y
Terui
Ken
K
Anzai
Jiichi
J
Sakihara
Satoru
S
Suda
Toshihiro
T
D000172:Acromegaly / Q000209:etiology*; D000236:Adenoma / Q000150:complications* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D003480:Cushing Syndrome / Q000209:etiology*; D005260:Female; D013006:Growth Hormone / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007333:Insulin Resistance; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D010911:Pituitary Neoplasms / Q000150:complications* / Q000378:metabolism / Q000473:pathology / Q000601:surgery
D001786:Blood Glucose; D007334:Insulin-Like Growth Factor I; D000324:Adrenocorticotropic Hormone; D013006:Growth Hormone; D006854:Hydrocortisone