Endocrine Abstracts

Introduction: Plurihormonality of pituitary adenoma can be defined as the ability to express more than one hormone. 1–30% of pituitary adenoma are plurihormonal. We describe a case of plurihormonal adenoma with GH and ACTH secretion and triple immunostaining for GH, ACTH and prolactin.

Case report: A 40 years old patient presented with sudden weight gain central obesity, hypertension, menstrual disorders, acne, hirsutism suggesting hypercortisolism. Laboratory evaluation confirmed Cushing’s disease (serum cortisol 0 h 234 nmol/l, cortisol after low-dose dexamethasone suppression test 613 nmol/l, ACTH 8 h 56 pg/ml). Furthermore, laboratory data showed elevated IGF1 levels (440 ng/ml, reference range 101–267 ng/ml) with elevated GH after HGPO (3.3 mUI/l). Prolactin, TSH, FSH and LH serum level were in normal range. The sellar MRI demonstrated microadenoma. Transphenoidal removal of the tumor was performed. Immunohistochemistry analyses showed staining for ACTH (40%), GH (80%) and prolactin (50%). Ki67 was less than 0.5%. Laboratory data realized after surgery were normal.

Conclusion: The majority of plurihormonal adenomas produce GH, PRL and TRH because lactotroph, somatotroph and thyreotroph cells have the same progenitor. Association of ACTH and GH secretion with positive immunostaining for GH, PRL and ACTH has not been described previously. These unusual plurihormonal adenomas exhibit aggressive behavior and poor prognosis. Plurihormonality of pituitary adenomas linked with ACTH co-expression seems to predict a higher risk of tumor recurrence. Furthermore, higher morbidity due to mixed ACTH and GH secretion needs a strict follow up.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.