Endocrine Abstracts

Case report: We present the case of a patient with somatotroph adenoma combined with neuronal choristoma Pituitary Adenoma Neuronal CHoristoma (PANCH). A female patient, 44 years of age, manifested with acromegaly type features since 1993, while mentioning also headaches, amenorrhea, and peripheral type visual disturbances since 1997. The clinical examination revealed an obese woman with typical acromegalic features. The laboratory evaluation before pituitary surgery showed a greatly increased IGF1 value of 995 ng/ml (normal values: 101–303) and basal GH value of 13.3 ng/ml (normal values: 0–5), while for the rest frontal pituitary lobe a low basal value of FSH 1.4 mIU/ml (normal value: 3–8) and LH 0.1–mIU/ml (normal values: 1–7) was noted, with normal values of PRL 4 ng/ml (normal values: 1.9–25), TSH 0.8 μIU/ml (normal values: 0.3–4.0) and T4 9.3 μg/dl (normal values: 4.5–12.5). The first pituitary surgery took place in 2/5/01. The histological evaluation of the resected pituitary section revealed a chromophobe somatotroph pituitary adenoma with sparse granulation, combined with neuronal choristoma (PANCH tumor), immunocytochemical positive for GH and focally for PRL. Because of acromegaly remission, a second and a third pituitary surgery followed at 5/6/02 and 13/11/03. She also received conventional radiotherapy in total dose of 54 Gy from 22/9 to 4/11/04. At present, she manifests thyrotroph, lactotroph and gonadothoph cell failure with normal IGF1 levels and the remaining pituitary tumor is stable in size. We present this case report because of its rarity (~0.5% of the hypophyseal tumors).