title: Acromegaly due to a Macroinvasive Plurihormonal Pituitary Adenoma and a Rectal Carcinoid Tumor.
abstract: A macroinvasive pituitary adenoma with plurihormonality usually causes acromegaly and hyperprolactinemia, and also accompanies with neurologic symptoms such as visual disturbances. However, its concurrent presentation with a rectal carcinoid tumor is rarely observed. This study reports the history, biochemical, colonoscopic and immunohistochemical results of a 48-year-old female with acromegaly and hyperprolactinemia. Despite the large size and invasive nature of the pituitary adenoma to adjacent anatomical structures, she did not complain of any neurologic symptoms such as visual disturbance or headache. Immunohistochemical staining of the surgical specimen from the pituitary adenoma revealed that the tumor cells were positive for growth hormone (GH), prolactin (PRL), and thyroid stimulating hormone (TSH). Staining for pituitary-specific transcription factor-1 (Pit-1) was shown to be strongly positive, which could have been possibly contributing to the plurihormonality of this adenoma. Colonoscopy found a rectal polyp that was identified to be a carcinoid tumor using immunohistochemical staining. A macroinvasive pituitary adenoma with concomitant rectal carcinoid tumor was secreting GH, PRL, and TSH, which were believed to be in association with over-expression of Pit-1. This is the first case report of double primary tumors comprising a plurihormonal pituitary macroadenoma and rectal carcinoid tumor.
authors.affiliation: Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea.
authors.forename: Sang Ouk
authors.initials: SO
authors.lastname: Chin
authors.affiliation: Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea.
authors.forename: Jin Kyung
authors.initials: JK
authors.lastname: Hwang
authors.affiliation: Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea.
authors.forename: Sang Youl
authors.initials: SY
authors.lastname: Rhee
authors.affiliation: Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea.
authors.forename: Suk
authors.initials: S
authors.lastname: Chon
authors.affiliation: Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea.
authors.forename: Seungjoon
authors.initials: S
authors.lastname: Oh
authors.affiliation: Institute of Pathology, Helmholtz Zentrum Munchen, Neuherberg, Germany.
authors.forename: Misu
authors.initials: M
authors.lastname: Lee
authors.affiliation: Institute of Pathology, Helmholtz Zentrum Munchen, Neuherberg, Germany.
authors.forename: Natalia S
authors.initials: NS
authors.lastname: Pellegata
authors.affiliation: Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea. igf1@unitel.co.kr.
authors.forename: Sung Woon
authors.initials: SW
authors.lastname: Kim
keywords: Acromegaly; Pit-1; Plurihormonality