ECE2018 Poster Presentations: Pituitary and Neuroendocrinology Clinical case reports - Pituitary/Adrenal (38 abstracts)
Acromegaly and subclinical Cushing’s disease: a rare case of a pituitary macroadenoma secreting both GH and ACTH
Teodora Teusan 1 , Mihaela Ciobotar 1 , Maria-Christina Ungureanu 1, , Cristina Preda 1, , Alexandru Florescu 2 , Voichita Mogoş 1, , Daniel Rotariu 3 & Letitia Leuştean 1,
1Department of Endocrinolgy, ‘St Spiridon’ Clinical Emergency Hospital, Iasi, Romania; 2‘Gr. T. Popa’ University of Medicine and Pharmacy, Iasi, Romania; 3Departament of Neurosurgery, ‘Prof. Dr. Nicolae Oblu’ Emergency Hospital, Iasi, Romania.
Introduction: Plurihormonal pituitary adenomas are unusual tumors which typically belong to one cell lineage and have an incidence of approximately 1.3%, the most common combination being GH, PRL and glycoprotein hormone subunits. There are a few cases in the literature describing cosecretion of GH and ACTH from a pituitary adenoma, the incriminated pathogenesis being the origin from different cell lineages and the aberrant patterns of transcription factors.
Case report: We report the case of a 49 years-old male patient who accused headaches and elevated arterial blood pressure. Physical examination showed a fully developed acromegaly, multiple papillomas and a lipoma, with no cushingoid features. Pituitary investigations revealed hypersecretion of both somatotrophic and corticotrophic axes and the MRI described a pituitary macroadenoma with compressive effects on the pituitary stalk and the optic chiasm. He underwent transsphenoidal surgery. The immunohistochemical staining confirmed the GH secretion with minimal expression of ACTH, PRL, TSH and relatively reduced proliferative activity (Ki67-7%). Postoperative follow-up revealed a tumoral rest with persistent hypersecretion of GH and ACTH, with no inhibition at low dose of dexamethasone. We obtained control of the acromegaly under somatostatine analogs and cabergoline, while for the corticotrophic component of the tumor, we considered appropriate in this case stereotactic radiotherapy. The patient currently is in observation regarding the effect of this therapy.
Conclusions: We describe an uncommon case of a mixt secretion of GH and ACTH from a pituitary macroadenoma; while we controlled the somatotrophic component, concerning the ACTH hypersecretion, we will take into consideration treatment with pasireotide in case of inefficiency of the Gamma-knife surgery.
Keywords: Pituitary adenoma, Growth hormone, Adrenocorticotropic hormone.
Article tools
My recent searches
My recently viewed abstracts
Authors
Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
© Bioscientifica 2024 |
Privacy policy |
Cookie settings
BiosciAbstracts
Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences.
Find out more