Acromegaly and somatotroph hyperplasia with adenomatous transformation due to pituitary metastasis of a growth hormone-releasing hormone-secreting pulmonary endocrine carcinoma.
BACKGROUND
GHRH excess from extracranial endocrine tumors is known to cause somatotroph hyperplasia and acromegaly. Hypothalamic gangliocytomas producing GHRH are also known to be associated with pituitary adenomas causing acromegaly.


OBJECTIVE
The objective of this study was to describe a case of acromegaly due to a pulmonary GHRH-secreting endocrine carcinoma with metastasis to the pituitary gland and to look at the peculiar histological features of this case.


METHODS
The patient was a 44-yr-old woman who was diagnosed with a biopsy-proven metastatic pulmonary endocrine tumor during pregnancy. After delivery, she underwent radiation and chemotherapy for pulmonary and skeletal metastases. Her disease was clinically stable for 7 yr until she developed bitemporal hemianopia. She had symptoms and signs of acromegaly.


METHODS
Imaging, biochemical, and histological studies were performed.


RESULTS
Magnetic resonance imaging (MRI) of the brain confirmed the presence of a 2.6-cm lesion within the sella turcica extending above the sella and compressing the optic chiasm. Endocrine studies showed elevated serum levels of GH, prolactin, alpha-subunit of glycoprotein hormones, IGF-I, chromogranin A, and GHRH. The patient underwent uneventful transsphenoidal resection of the sellar tumor. Postoperatively, she noted an improvement in symptoms of acromegaly. Histological examination confirmed metastatic endocrine carcinoma to the pituitary, and immunohistochemistry localized GHRH to the tumor cells. The adjacent pituitary exhibited somatotroph hyperplasia with abundant reactivity for GH and alpha-subunit. In addition, there was focal neoplastic transformation to a sparsely granulated somatotroph phenotype with fibrous bodies.


CONCLUSIONS
This is the first report of a GHRH-producing endocrine tumor metastasizing to the pituitary and causing local hyperstimulation with somatotroph hyperplasia and adenomatous transformation.
Nasr
Christian
C
Department of Endocrinology and Metabolism, The Cleveland Clinic Foundation, A53, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA. nasrc@ccf.org
Mason
Alexander
A
Mayberg
Marc
M
Staugaitis
Susan M
SM
Asa
Sylvia L
SL
D000172:Acromegaly / Q000150:complications* / Q000209:etiology*; D000236:Adenoma / Q000000981:diagnostic imaging / Q000209:etiology*; D000328:Adult; D002277:Carcinoma / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000378:metabolism; D005260:Female; D013007:Growth Hormone-Releasing Hormone / Q000378:metabolism*; D006423:Hemianopsia / Q000000981:diagnostic imaging / Q000209:etiology; D006729:Hormones, Ectopic / Q000378:metabolism; D006801:Humans; D006965:Hyperplasia / Q000150:complications / Q000209:etiology; D007205:Indium Radioisotopes; D008175:Lung Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism; D009384:Paraneoplastic Endocrine Syndromes / Q000150:complications*; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic; D011859:Radiography; D011877:Radionuclide Imaging; D052683:Somatotrophs / Q000473:pathology*
D006729:Hormones, Ectopic; D007205:Indium Radioisotopes; D013007:Growth Hormone-Releasing Hormone