Pituitary

, Volume 3, Issue 3, pp 159–168

Double Pituitary Lesions in Three Patients with Cushing's Disease

  • Björn P. Meij
  • Maria Beatriz S. Lopes
  • Mary Lee Vance
  • Michael O. Thorner
  • Edward R. LawsJr.
Article

DOI: 10.1023/A:1011499609096

Cite this article as:
Meij, B.P., Lopes, M.B.S., Vance, M.L. et al. Pituitary (2000) 3: 159. doi:10.1023/A:1011499609096

Abstract

Double pituitary adenomas are rare in surgical specimens and the most common clinical feature in reported patients has been acromegaly. We report 3 cases of double pituitary lesions in patients who presented with Cushing's disease. In a 22-year-old man (case 1) with delayed puberty and low testosterone levels, mild hyperprolactinemia was diagnosed and treated with dopamine agonist therapy that reduced the prolactin (PRL) levels to normal. Over a 1-year period Cushing's disease developed gradually and was confirmed with classical endocrine testing. In a 27-year-old woman (case 2) who initially presented with severe depression and morbid obesity there was a gradual onset of Cushing's disease; initially she had minimally elevated serum PRL. In a 33-year-old woman (case 3) there was a 2-year history of Cushing's disease characterized by hirsutism, hypertension and weight gain; serum PRL was normal. Magnetic resonance imaging in all 3 patients revealed a microadenoma that was successfully removed by transsphenoidal pituitary surgery. Histology and immunocytochemistry in case 1 and case 3 revealed a corticotroph cell adenoma and a PRL cell adenoma in separate areas of the pituitary. In case 3 the PRL cell adenoma was “silent” but in case 1 the PRL cell adenoma may have been the cause of the mild hyperprolactinemia. In case 2 nodular corticotroph hyperplasia was the cause of Cushing's disease and a “silent” PRL cell adenoma was also identified.

We conclude from these cases and a literature review that double pituitary lesions may occur in patients with Cushing's disease. The corticotroph part of the double lesion may consist of a corticotroph cell adenoma or, as reported in this study, of corticotroph nodular hyperplasia. The counterpart of the double lesion may consist either of a “silent” PRL cell adenoma or a functional PRL cell adenoma causing hyperprolactinemia.

double adenoma pituitary Cushing's disease immunohistochemistry electron microscopy nodular hyperplasia 

Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • Björn P. Meij
    • 1
  • Maria Beatriz S. Lopes
    • 1
  • Mary Lee Vance
    • 2
  • Michael O. Thorner
    • 2
  • Edward R. LawsJr.
    • 1
  1. 1.Departments of Neurosurgery, Pathology, Health Sciences CenterUniversity of VirginiaCharlottesville
  2. 2.Department of Internal Medicine, Health Sciences CenterUniversity of VirginiaCharlottesville

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